Barbie lives just 5 minutes walk from the back of the hospital in Kisugu. This is one of the parishes/zones that we reach into with our Touch Namuwongo programme. In the last two years Touch has continued to extend its services, some of which can be seen on the poster above.
Whilst the provision of these health services no doubt makes a difference in the lives of those touched, what Barbie really needs is a comprehensive uplift of basic services including:
- Safe water closer to home which can save the many hours spent fetching and carrying those jerry cans; clean, safe water can help to prevent diarrhea, a very common ailment.
- Improved sanitation; put simply, more toilets and less human waste in the streets.
- Rubbish collection and removal; if you’ve ever walked these streets you will know just how big a problem this is.
- Indoor spraying (perhaps also in the local environment) and provision of bed nets to help reduce the huge impact of malaria.
- Better, more affordable housing.
- Good education,that remains affordable and accessible throughout her teenage years.
- Stimulation of local business and income generation.
These basic services (some would refer to them as rights), combined with holistic health services, could so easily be provided. The change would be transformational.
What we need are honest, hard-working local politicians who have a heart for the people and understand that they are elected to serve.
Together We Can…
Over the last 3 years, I’ve had the great pleasure of watching our work in Lira grow and reach more and more of the people in that community with an ever-increasing range of services.
Earlier this year we relocated to a facility owned by Charis, represented by Dr. Joel at the far left in the photo above.
Since then Dr. Leonard (2nd left above) and his team have been able to extend the services to include in-patient care, particularly for young children with severe malaria. The team has expanded its maternal health services, through Yer Yotkom which is focussing on reproductive health, preventing unwanted pregnancies and preventing the transmission of HIV between mother and child and by offering safe delivery.
Next year we will build an operating theatre suite which will allow the team to perform C-sections and emergency obstetrics care. Dr. Mike, on the far right above, has committed to providing the funds to buy and install all of the necessary equipment for this. Dr. Richard and Patricia have started to raise funds in the UK to meet the cost of building the theatre.
Also pictured above with Dr. Ian Clarke is Phil Knight who will manage the building project.
Once the theatre is completed the Charis-IMC centre will be designated a Health-Centre-4, which is the small hospital category, with facilities capable of providing safe maternity services and some minor operations. Such centres usually provide service for local populations of 50,000 – 100,000. Given its population Lira should have 4 such facilities; currently there are none and the regional referral hospital is desperately overcrowded, under-staffed and lacking some essential facilities.
In the last year we have been working with the management team at Bwindi Community Hospital to establish a community based health scheme, which we refer to as eQuality Health. Community groups, such as the Bataka pictured above, organise themselves to make payments of $3 per group member per year. This small contribution entitles each member to a wide range of services at the hospital and at the community based outreaches.
Our role is to work with the community leaders to help mobilise the members, bank the collections and to make payment on a regular basis to the hospital, but only after we have performed a 25-point quality assurance review of its services.
Clearly this contribution only covers a small part of the overall costs of service and BCH continues to rely on its many donors and supporters.
Such community based schemes are an important means of financing health service delivery, but these can never be expected to raise all of the monies that are needed to provide even the minimum healthcare package. The WHO estimate that cost at almost $40 per person per year, a great deal more than the $3 which eQH raises. Our experience to date indicates that it will be difficult for this community, which is very poor and living essentially a non-cash subsistence lifestyle, to contribute much more than this, perhaps no more than $5-$6 each in a few years time.
The gap in funding will either need to continue to be met by donor countries and international supporters or perhaps in time the Government of Uganda may be able to pay more to the health budget from either an increasing tax-base or hopefully the future oil revenues.
IHK performed its first open heart surgery on April 13th 2007. You can read more here.
OHS is very complex and expensive. Each of these procedures costs about $7,000 (which compared of course to other countries is still very good value for money). Each is performed on a charitable basis, largely due to generous support from Hwan Sung.
So why do we do this, why do we spend so much on one patient when we know that the same funds would help so many others with less complicated conditions?
As mentioned in Day 16 we do debate this on a regular basis.
- There is a very significant need for such care and treatment. There are many living in Uganda with heart conditions that severely impair the quality, and perhaps reduce the length, of their lives. So these procedures can be life-saving.
- We have access to some donors who want to support this particular need. These funds are essential as the patients can not afford to meet the cost of the procedure.
- At IHK the operations are performed by a visiting consultant, Dr Clement Akomea Agyin, a consultant cardiac surgeon currently working in St Anthony’s Hospital London. He is usually accompanied by a perfusionist; Mr. John Francis Nelson has filled this role in the past. The rest of the team is staff at IHK. This is therefore an important way to develop local capacity, training staff that in the future may be able to perform such procedures without assistance from overseas.
- Each time we perform an OHS camp our management team re-assess the state of equipment and the training levels for staff in the theatres and in the Intensive Care Unit. This drives up our internal standards and capabilities, meaning that we are then more able and better prepared to provide safe, quality care to our other ICU and emergency care patients.
We believe in developing local staff and facilities to perform and deliver across the full spectrum of healthcare, from public health through primary care up to and beyond the tertiary level required for OHS. We are doing this using a financial model that combines local, sustainable private business, IAA Healthcare, and some donor supported initiatives, such as OHS.
Masters in Public Health students graduating at IHSU
On Saturday 18th December IHSU held its first graduation ceremony.
In the photo above The Chancellor, Hon. Justice Julia Sebutinde, awards 31 students their Master of Science in Public Health. The Vice-Chancellor, Dr. Nick Wooding stands with her and The Chairman of Council, Dr. Moses Galukande looks on from the stage behind. The Dean, Prof. Dr. David Ndungutse, can be seen having just read the name of each graduand.
The graduation is another significant milestone in the development of International Medical Group.
International Health Sciences University is a niche university offering health-related courses. IHSU provides professionally-trained workers for the health sector in various specializations and continuing medical education for health professionals already working in the field, with the specific aim of making a difference to health care in Uganda.
International Medical Foundation (IMF) provides public health and primary care to the communities living around IHK and the up-country clinics (mentioned in Day 12). This includes for example: health education, family planning, reproductive health, HIV testing and treatment, immunizations and treatments for the common acute conditions such as malaria, respiratory infections and diarrhea.
We operate these services on a cross-subsidised model, meaning that our community work is not charged for facilities, it does not contribute towards central services such as HR, IT and Finance and some of the clinical staff costs and most of the management staff costs are paid by IHK and IAA (the private-for-profit companies within International Medical Group).
On the whole these community services cost about $7 per patient treated. Some of the services are supported by funded programmes such as Yer Yotkom and Touch Namuwongo, in which case the care and treatments are free of charge to the community. For those services that are not funded we sometimes ask the patient to make a small contribution of up to $3. This is how we are providing the clinic services at Charis-IMC in Lira. The charge for a child with malaria is a flat-fee of just $2 which includes the consultation, test and treatment, which may sometimes need to include IV fluids and an overnight stay on the in-patient ward. The actual cost of these clinical treatments can be as much as $15.
Our thanks and appreciation go out to the sponsoring corporates both in Uganda and from overseas and the many individual supporters and well-wishers from across the globe. Your continued support and funding allows us to continue to extend the scope of our programmes ensuring the provision of more holistic care and treatment.
So okay I know it’s not a photo.
This is one of the more interesting discussions that we’ve had at board level over the last year. Should we spend $7,000 to help 1 patient or 1,000 patients?
We’ve decided to do both, for various reasons, which perhaps the next two posts will help outline.
Calvin is just one of our many hundreds of patients treated free of charge in Hope Ward. He had operations regularly with us for over two years, after which he was able to go back to school at the age of 25.
Elephantiasis is an infection that blocks lymph drainage from the legs. They swell over many years until they are the size of elephant legs. You can read more about Calvin’s treatment and see the before and after photos (which may upset some) by clicking on the photo above.
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.
We are very proud of all our staff at IHK and of course it takes more than just doctors and nurses to keep a hospital operating. Our maintenance team do a great job at keeping the hospital clean and safe; thanks.