Alison and Michelle Raise more than £3,300

Alison and Michelle

Alison and Michelle raised more than £3,300 from their family and friends who sponsored their recent marathon in Edinburgh.

These funds will be used to continue supporting the STI clinic in Makindye division, Kampala. This clinic provides counselling, testing and treatment, free of charge, to those that could not otherwise afford to access such care.

The clinic is an integral part of our Touch Namuwongo Programme which also provides counselling, testing and treatment for HIV/AIDS and TB. We are currently planning to extend these services to include safe male circumcision.

In recent years about 20,000 adults living in Makindye division have accessed services from the Touch programme.

Our thanks also to Helen for her continued support for the STI clinic.

Exam Time

I sat in the exam room staring at the paper and slowly it dawned on me, I couldn’t answer any of it. I could feel the panic rising and, as is normal in this situation, I was buck naked.

Last week International Health Sciences University, in Kampala Uganda, held its 2nd Graduation Ceremony. 91 students graduated, 35 of whom successfully attained their Master of Public Health, MPH.

Justice Julia Sebutinde awarding degrees to the Master of Public Health students at IHSU.

This is still a very young institution and for those in the UK, these numbers might seem quite small, but I think they are significant for these two reasons.

According to the WHO World Health Statistics Report 2011, Uganda has just 1.2 Physicians per 10,000 population and 13.1 Nurses/Midwifes. In the UK these same counts are 27.4 and 103 respectively. Uganda has a serious shortage of trained doctors and nurses.

In the last few months I have had discussions with directors of health service providers in Uganda who are finding it very difficult to recruit and retain such trained medical staff, especially for rural up-country settings. One of the challenges facing us is that Donors and NGOs are also actively recruiting such staff and they are willing and able to offer higher remuneration packages. This is somewhat ironic when you consider that the aims of these worthy organisations is to help strengthen the country’s health system. The positions being filled are most often programme design, implementation, management and evaluation, not clinical roles. So we see Clinicians being removed from clinical roles and appointed to programme management.

Wouldn’t it be so much better if these roles were filled by non-clinicians, trained and skilled in public health? That’s one of the ways in which IHSU is trying to make a difference to the delivery of healthcare in Uganda; by providing well trained, willing and able graduates who can implement and manage public health programmes, leaving the doctors, nurses and midwifes to continue treating and caring for our patients.

My second reason is that studying for your MPH involves a lot of relevant reading, discussion and, most importantly, critical analysis. It is my own personal experience that such exposure helps make us much more considered in how we approach the design, implementation and evaluation of required interventions. I think I’m a lot less naive than I was a few years ago. I used to wonder why we couldn’t just get on with it, to do it, to make it happen and quickly (whatever “it” was).

Some of my recent public health conversations have been about the reported unmet need of family planning; according to Guttmacher, 7 out of every 10 women in Uganda who want to avoid pregnancy, cannot easily and regularly access such services. I can hear you say, “surely that must be easy to fix, and it’s cheap, an IUD costs just a few pence.”

Of course it is much more complex and there might be many reasons why an unmet need exists. There will be numerous hurdles to overcome to ensure a sustained delivery of accessible and affordable service.

Those MPH students graduating last week are now well equipped to tackle such matters and better placed than they were before to now ensure successful achievement of the desired outcomes.

Hopefully I’ve now finished my exams and can move on to starting my research and learning some more. Many years ago I used to have the dream (nightmare) outlined above, thankfully it’s never been reality.

Tuberculosis Health Needs Assessment (2/2)

A key element of this study was to assess the housing as well as socio-economic determinants amongst slum dwellers.

1,366 households were surveyed in 3 low income settlements; one in the urban slums within Kampala and the other 2 in rural settings as a comparison.

As indicated in the previous posting there is a need for closer collaboration between the various agencies responsible for TB and for Housing.

Kisugu TB health needs assessment

Some of the survey findings are:

  • 66% did not own their property
  • 48% of properties had just one room, which on average was just 12 m2
  • Average of 5 people per property
  • Average of 3.8 people sleeping per room
  • 66% used a communal latrine

Kisugu TB health needs assessment

We don’t have the capacity to stay in good houses. We stay in houses we can afford to pay for, which exposes us. We stay in houses without windows; mosquitoes bite you and with leaking roofs.

When you think of going back to the village, then you think about the hard life there…the places we stay in are surrounded by drainage channels which flood and this makes it easy to contract diseases.

However, we find ourselves in a situation we have no control over.

Slum dweller, Kampala.

For a copy of the full report please email: imf@img.co.ug

Dr. Alison Raising Funds for Touch Namuwongo

A recent post by Dr. Alison described how she helped to establish an STD Clinic within the Touch Namuwongo Programme in Kampala.

This summer Alison, Alan and their family raised £1,171 to help support this programme by speaking at a local church lunch and hosting a Ugandan party for supportive friends in her native St Albans.

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Alison (on right in photo above) sent us this message:

We wanted to update you after our latest fundraising venture on 16th July. It was a fantastic evening of fun and frolics in the community centre around the corner from us and was well-attended with over 80 people. Whilst people could still concentrate, we kicked off with a talk from us about our time in Uganda including the work of the Suubi Trust and the Royal Pride School in which Alan was involved. We raised a total of £1168 which we will split evenly between the 2 causes (£584 each). Everyone came in the Ugandan colours and some draped in the Ugandan flag.

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(Alison’s husband Alan is in the centre in the photo above)

So, in summary, this means that the first church event raised £587 and this latest event raised £584 – a total of £1,171.

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Our thanks to Alison and all her friends for their generosity and continued support; this will help to make a difference for many of our Touch clients receiving care at this clinic.

UK Aid as a share of National Income

In the last few weeks there’s been a lot of discussion about UK overseas aid. (on Twitter #AidReview)

DFID has just completed a thorough review of all the programmes that it supports and has announced some changes planned for the next few years.

Essentially the UK Government is committed to sharing up to 0.7% of our national income to deliver results such as:

  • secure schooling for 11 million children – more than we educate in the UK but at 2.5% of the cost
  • vaccinate more children against preventable diseases than there are people in the whole of England
  • provide access to safe drinking water and improved sanitation to more people than there are in Scotland, Wales and Northern Ireland
  • save the lives of 50,000 women in pregnancy and childbirth
  • stop 250,000 new-born babies dying needlessly
  • support 13 countries to hold freer and fairer elections
  • help 10 million more women get access to modern family planning.

Getting to 0.7% will mean an increase of some 50% in cash terms over the next 4 years.

I first came across this chart on Owen Barder’s Blog:

In his announcements last week Andrew Mitchell noted that UK Aid to Uganda will increase from £68m pa to £98m and will be focussed on these top priorities:

  1. Improving the quality of essential services, especially for the most vulnerable
  2. Supporting the recovery in northern Uganda
  3. Improving maternal and reproductive health
  4. Driving growth through training, job creation, financial services and trade
  5. Improving government accountability and transparency so that future oil revenues are spent effectively.

I am hoping that our projects in Lira and in the Makindye Division of Kampala might benefit from some of this funding, as we seem to be closely aligned on the first 3 in particular.

IMG – Doing Business as a Means of Development

Suubi Trust continues to support the work of International Medical Foundation, IMF.

IMF, one of four companies within International Medical Group, is the group’s NGO (registered charity) providing a wide range of charitable health services to the poor ranging from community based health education, preventative services including family planning and ART, TB diagnosis and treatment, complex medical and surgical procedures and oncology. IMF receives funding from a variety of sources including international donors, businesses in Uganda and UK, individual supporters from around the world, Suubi Trust and from International Hospital Kampala, IHK, its largest donor.

IHK, is the largest private health service provider in Uganda and has gained an enviable reputation for the safety and high quality of the care provided. This is reflected, for example, in its successful performance of 29 open heart surgeries in the last 3 years and the specialist trauma and intensive care provided to the victims of last year’s bombings in Kampala.

IAA Healthcare is Uganda’s leading provider of pre-paid health schemes, with 40,000 members being served in IHK and at 9 health centres across the country.

International Health Sciences University, IHSU, is now in its third academic year with 600 students of nursing, health management and public health.

IMG is one of Uganda’s larger employers, with more than 750 staff. It generates income from its pre-paid members and those patients paying cash for service. IMG is not government or donor funded and as such is an excellent model of private business as a means of development.

You can read more about IMG here.

Bomb survivor’s slow and bumpy road to recovery, four months later

Sadly, Francis died at the weekend, may he rest in peace. The item below was one of his last interviews.

>>>

Posted at: http://bit.ly/dmLQWn

By RACHEL KABEJJA:
Posted Thursday, November 11 2010 at 00:00

Francis Semwogerere after two months in hospital. INSET, Semwogerere on arrival at the hospital after the bomb blasts. PHOTO BY RACHEL KABEJJA

It is exactly four months since the twin bombs went off in Kampala. About 80 people were killed and others left with severe injuries among whom is Francis Semwogerere, an IT engineer with Hunger Free World. While many of the injured victims could have left hospital and are recovering from their homes, Semwogerere is almost just starting his medication. He had his major surgery on September 27, 2010 and has two more to go; one operation to remove the sharp metal from his spinal cord and the other to rectify the damaged lung.

According to Dr Patta Radhakrishina, a surgical gastroenologist flown in from Apollo Hospital India to perform the operation, this surgery was aimed at having control on Semwogerere wind and food pipes. These were damaged by the metal which cut through the neck to the spinal cord. The damage made his breathing difficult and the food and saliva, instead of going to the stomach, started flowing to the lungs hence damaging one of them.

During the operation, a new food pipe was created and stitched to the neck. This was to help him feed before he gradually learns to feed on his own in about a month hopefully. “On his arrival at Kampala International Hospital (IHK), we thought he had one injury in the neck,” says Dr T. Prasandan, director of the Cardiac Centre at IHK. “However, we later realised that he was losing a lot of blood and had breathing difficulties.

His oxygen levels were also going down and his limbs were paralysed. That is when we performed a scan and X-ray to examine the exact problem. The results showed that he had a metal in his spinal cord and we did an emergency surgery to put a tube into the breathing pipe to stop blood from flowing to the lungs.”

The fateful day
Mr Semwogerere’s wife, Grace Nassanga, a midwife at Nsambya Hospital, says her husband left home at about 7:30p.m. to go and watch the final World Cup match. “He is a football fan but watches almost all his matches from around home. I didn’t know where he was watching the match from but when I heard about the bomb blasts, I called him. This was at about 11p.m. The person who picked the phone told me that he had an injury on his arm. I thought it was a lie. I asked the person who answered the call to tell me the truth and he reaffirmed his statement.”

“When, I arrived at the hospital and found him gasping for breath, I couldn’t believe it, I was so shocked and more so that the doctors, on his arrival at the hospital, thought he had only one injury so they were supporting his neck while blood was flowing out of him. Later, they realised that it could be more than one injury so they took him to the scan and X-ray to find out the exact problem.”

About how he ended up at Kyadondo to watch the match, Ssemwogerere says; “I was driving from Nakawa to town but the traffic jam seemed unbearable that is why I decided to go to Kyadondo Rugby Club. While there, I heard a blast, and in my attempt to flee the area, I fell down in a trench. When I turned to look, my neck was bleeding. Then a certain O.G of mine assisted me to get transport to AAR but they (AAR) couldn’t handle my condition so they referred me here (IHK),” says Semwogerere. This is all he remembers about the incidence which has changed his life.

His wife says; “He did everything in his power to give us the best care. I have consoled myself with prayers and accepted the situation although I regret why he went there.” “I can’t wait for him to be discharged from hospital because our five-year-old daughter asks for her daddy every day. I tell her that daddy is in hospital but will return home shortly.”

After surgery
The doctors are hopeful that he will recover since he is responding well to treatment but he will face some challenges. A formerly able bodied man, full of life, a career and family to take care of, Semwogerere may never walk again as his lower limbs are completely paralysed. He may also have difficulties controlling his bowels. He needs more support from family and rehabilitation after surgery. He had emotional disturbances (like the fact that he can’t provide for his family) but will hopefully be better after the two operations that are yet to be performed on him depending on his progress after each operation is done.

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!