Dr. Alison (VSO) working with Touch Namuwongo

Alison with her familyAlison Cowan, a GP from the UK, and her family have recently returned after a fabulous 18 months in Uganda working with the IMG group through the charity VSO. She came to Uganda initially to facilitate the training of medical staff across the various IMG primary care clinics. Through this work she came to appreciate the enormous burden of sexually transmitted disease (STD) and its devastating consequences within Uganda and especially Kampala and recognised the need for a comprehensive sexual and reproductive healthcare service. So, once her original placement objective was fulfilled, she extended her placement to work with the Touch Namuwongo Team based at the International Hospital of Kampala (IHK), within the neighbouring communities, to tackle this growing problem of STDs.

Even though STDs are very prevalent in Kampala, and are responsible for a lot of death and disease, very little attention and minimal resources are focused on this area, beyond HIV. The Touch Namuwongo team work with the poorest members of the Kampala community local to IHK and offer services for HIV, TB and STDs. With respect to STDs, prior to Alison’s involvement, the team were just able to treat the symptomatic cases in their hospital clinics and community outreach. However, this approach was only scratching the surface of the problem as 50-70% of disease can be silent. There was no system or resources in place to identify and screen those members of the community most at risk from these diseases and who were often without symptoms. As well as unknowingly transmitting these diseases on to others, the presence of STDs also facilitates transmission of HIV so further fuelling the HIV epidemic. Alison developed a risk score tool capable of identifying such members of the community and which would also then appropriately target their limited resources to the most in need of treatment. Despite resources being very stretched, with the enthusiasm and commitment of the Touch Namuwongo team, the support of IMG and the help of kind donations they were able to get establish a comprehensive service which identified both symptomatic and asymptomatic disease.

Alison also obtained some funding from Oxford University to carry out a research project that aimed to derive and validate this risk score tool. As an associated benefit, the study also funded a large volume of screening and medicines for treatment of STDs in the data gathering process.

The Touch Namuwongo team took on the extra burden of work involved in the study without complaint and worked tirelessly to deliver the service and also produce the data which is in the process of being analysed to develop an effective protocol going forward.

Alison with Immaculate one of theTNP team

Initially Alison was heavily involved in the actual running of the clinics, but by the time Alison returned to the UK, the team was delivering the service without any additional input and continues to do so with great effect, despite the challenges and hard work this entails. Even though the clinics are already very busy, the team recognise what a valuable service it provides and so continue to reach out to the community to encourage others to be screened and treated, especially those communities where the need is greatest. They have got a good relationship with the local commercial sex workers, who continue to attend the clinics and who themselves are becoming advocates of the service.

The research funding has now drawn to an end and so there is a desperate need for on-going funding to continue to deliver this valuable service. Alison continues to raise funds for the STD programme through Suubi Trust, recently speaking at a local church lunch and is soon hosting a Ugandan party for supportive friends in her native St Albans.

The team with some added extras Alison’s children

Uganda VSO Health Recruitment Film

VSO has been a great organisation for us to work with; each of the volunteers have made significant contributions to the development of our healthcare services at International Medical Group.

This video features Dr. Richard and I am so glad to hear him say that he got as much from his time here as we got from him, which believe me was massive. His influence continues through his ongoing support for our TB Lab and community hospital in Lira. We need more like him…

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.”

Advent: Day 7 IMF Dunavant Mobile Clinic

Lucy, Amy, Tom (volunteers from the UK) and members of our clinical team from Lira spent a few weeks on this pilot in Pader District to help determine how we might be able to operate Mobile Clinics in parts of the country that lack basic health facilities.

The pilot was a success but we’ve failed, so far, to interest other sponsors to help fund such an operation.

Advent: Day 5 Judith Nyesigire

This photo is from June 2008, before I came to work full-time in Uganda. Judith, in the middle, worked with the communities in and around Jinja, helping to train and support the community health volunteers. We had a very interesting day watching her interact with these volunteers and teaching them to tell others about HIV/AIDS. Click here to read more.

Sadly less than a year later Judith died, she too becoming another maternal health statistic.

Such a loss, that in another place and time, may have been prevented. We miss her.

Also in this photo, Helen Lay who came with VSO and worked for 2 years helping to professionalise our management and accounting processes. Jemimah Kiboss-Kyeyune continues her role today as the IMF Programme Manager. In the distance is Ian’s car that I borrowed for the day and had to abandon due to the poor road conditions!

A happy day but now tinged with sad memories.

Advent: Day 3 Touch Namuwongo

I really like this photo which I took during an open day for the Touch Namuwongo Programme at IHK. It was just great to see so many of the local children taking part in the events in the hospital grounds.

Our vision is that IHK would help to serve all of the people living in our Division, not just those that can afford to pay for it.

Touch has become a more holistic programme over the last few years thanks to the funds from Civil Society and great work and committment by the team and it’s leaders.

Having started as a simple HIV/AIDS testing programme this has now grown to provide HIV treatment, family planning, TB diagnostics and treatment, screening services for STIs and cancers. A recent initiative resembled “Dragon’s Den” helping to support the community volunteers in their income generation ventures.

“…at the heart of the community with the community at its heart”

Dragon’s Den- African Style!

Alan and Alison posted this about one of our latest initiatives on Touch Namuwongo – hoping to help the community with income generation… original post here

 

As part of the income generation project with the Touch Namuwongo Community volunteers, Alan organised a Dragon’s Den style forum for the volunteers to pitch their business ideas to a panel of experts. On the panel were Alison’ brother, Jonathan who is an investment banker in London, Kevin the CEO of International Hospital Kampala, our friend Amos who runs a tour company in Uganda, and Rita, a lawyer from the hospital with experience in similar microfinance schemes.
Using funds from donations and some of the ‘dragons’ own money, we are distributing loans to the ideas deemed most innovative and likely to succeed. In the first session we had ideas ranging from a fish mincing machine to an ID card business. The other volunteers watched on and hopefully learnt some valuable business skills for their own ventures.
Once the loans are paid back over a 6 month period, the process will start again and the money will be ploughed ino the next winning entries.

This guy is pitching for funds to expand his onion selling business. The dragons are sat on the right.

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!