Programme Successes: KCCL, HIPS and IMF in Kasese

By Clodagh:

The most obvious success has been the reduction in the number of people who have been tested to be HIV positive. This has fallen from 26% at the beginning of the project to 9% at the end of 2011. Overall, 18% of people tested from December 2006 to 2011 were HIV positive. This HIV rate is high compared to the national average of 6.7%.

Since the project started the community members and peer educators report a general improvement in the communities’ attitude towards health and hygiene. Additionally, staff, patients and peer educators report that there has been an overall reduction in the stigma towards HIV since the beginning of the project.

The education in schools is also beginning to have an effect as children are now aware of the social problems in their area. Hopefully this will have a positive effect in the future.

An obvious indication of the success of the project is the expansion that has occurred since its establishment. The most recent of these is the HIPS funded training in long-term family planning, which occurred over the last week in July 2011. This allowed the staff and other nurses from the area to gain experience in educating, counselling, prescribing contraception and inserting implants. This demonstrates the more comprehensive healthcare that is now being provided by the project.

Family Planning In Kasese

KCCL, HIPS and IMF Project in Kasese – Case Study 2

By Clodagh:

Mr X lives in Kahendero and married 7 years ago. His two sons were born over the next two years, both of whom are HIV negative. Mr X had to leave the village and live in Kasese in order to earn enough money to support his family. During this time he reckons that his wife was “with many men”. His wife then left him after two years to marry another man and has subsequently had two children who are both HIV positive.

Mr X was tested at an outreach clinic 5 years ago and was found to be HIV positive. He is on ARV treatment and is doing well. According to him he would have been dead by now if it weren’t for the community project.

Programme Challenges: KCCL, HIPS and IMF in Kasese

By Clodagh:

There is still a major problem with alcohol in all three areas, which has a direct negative impact on the treatment of HIV in the area. It is relatively common for the clinic to be interrupted by drunken members of the community. Additionally, patients sometimes turn up to the clinic whilst under the influence of alcohol, making it very hard for the clinical staff to carry out consultations. It also suggests that this is a common occurrence for the patient which can be detrimental to their treatment as they may forget to take the medication and may also spend their money on alcohol instead of food.

Another area that causes concern for the staff is the difficulty of accessing CD4 counts. Originally the blood samples where taken to Kilembe Hospital but this was unreliable and became expensive. At the moment the staff have to organise private transport to Kampala and then carry out a mass blood-taking early in the morning so that the blood samples can be rushed straight to the lab in IHK. This is problematic as it is hard to procure transport and so can only be carried out a couple of times a year. Additionally, the population is quite unreliable so it can be quite hard to get all of them to turn up at the same time on one day. As a result, it is very hard to get regular CD4 counts for the entire population. This would be made much easier for staff if it were possible to carry out the blood tests in the Kasese area.

An initiative that has been recently started in the community and has proven to be successful is the breeding of goats. A pair of goats were given to a number of families who then give two of the offspring to another family. This is a long-term solution as time is needed to build up a herd of goats and so, in addition, we need more immediate projects to help improve the economic state of the areas as soon as possible.

KCCL, HIPS and IMF Project in Kasese – Case Study 1

By Clodagh:

Mrs A, a young woman with a 7 year old son who lives in Muhokya in a single roomed wattle and daub house with no bed. She was previously a sex worker and now lives alone with her son. They survive by collecting fire wood in the park and then bringing it back to sell in the village.

She attended an outreach project in January 2011 where she was found to be HIV positive. She is currently receiving ARV treatment. She developed uro-genital warts which the clinical officer attempted to treat in the community. However, this failed so the CO managed to raise the funds for transport for the patient and a caregiver to Kampala and have her admitted to Hope Ward. She spent 6 weeks at IHK where she underwent surgery to remove the warts. She was discharged on 28th July 2011.

The clinical officer helped to find Mrs A. a sponsor, who will work with her to start a small business such as a shop. In this way she will be able to support herself and her son in the future.

Communities Being Served – KCCL, HIPS and IMF

By Clodagh:

Kasese is in the West of Uganda and this programme is operating in communities on the shores of Lake George.

All three of the communities being served, which have an approximate total population of 10,000, suffer from extreme poverty. This is mainly due to their near sole dependence on small-scale fishing, the produce of which is sold in the local market. The local people are unable to afford large fish so the fishermen must catch small, immature fish. As well as being illegal, this may be putting the future sustainability of this activity at risk.

The simple fishing boats used in the area

Inhabitants of both Kahendero and Hamukungu are unable to farm the land as they are within the boundaries of Queen Elizabeth National Park. They are forbidden from growing crops by the park authorities and any cattle owned by the community members are under constant danger from predators such as lions. As a result the population survive on a diet almost solely comprising of fish.

Living conditions are poor with housing consisting almost entirely of small wattle and daub houses with one room per family. Most do not contain a bed and are only furnished with a couple of cooking utensils. Additionally, toilets are few and far between and the majority of the locals are forced to resort to the bush despite the obvious dangers from the park’s wildlife.

Typical housing in the area

Water is also a problem as many of the inhabitants of the community have no access to a fresh, clean supply and so they are forced to drink the lake water. This is the same water that is used for washing, bathing etc. and has lead to numerous outbreaks of diseases such as cholera, dysentery and typhoid.

All of the communities contain a primary school and Hamukungu has its own secondary school. Yet there is a major problem with absenteeism as many pupils go out fishing on the lake instead of attending.

The communities receive little other healthcare and any problem that can’t be dealt with by the project must be referred to Kagando or Kilembe hospitals. Yet this in itself can cause problems as the hospital can be up to 40km away from the patient’s house and many cannot afford the cost of transport. Even at these hospitals there is no access to facilities such as X-ray, scans etc.

This poor socio-economic status in the communities has lead to feelings of hopelessness. This, coupled with the boredom of small town life and lack of activity, has caused many to resort to alcohol. The resulting problem with alcohol abuse, in conjunction with the large number of sex workers in the area, has lead to an increase in HIV high-risk behaviours and therefore greater vulnerability to HIV infection. Additionally, it perpetuates the vicious cycle of poverty.

Map KCCL

IMF Working with Kasese Cobalt Company Limited: Update

Thanks to Carolyne for this update:

International Medical Foundation has been working with Kasese Cobalt Company Limited since October 2006 to provide basic health services to the poor living in three communities close to the KCCL facility in Kasese, West Uganda; Muhokya, Kahendero and Hamukungu.

This programme has been supported by Health Initiatives For The Private Sector, HIPS, a USAID funded project.

Together we have provided HIV voluntary counselling and testing to 4,151 adults, of which 638 tested positive. We have enrolled 467 onto our treatment and care programme and currently 161 are receiving anti-retroviral therapy, ART.

Those enrolled are able to have regular health checks, including a CD4 test which provides a clinical indication of the strength, or weakness, of their immunity system. When the CD4 count has fallen to a given threshold the client is then started on ART.

From time-to-time we are able to provide other health related support, such as these, which we were able to provide in 2011 thanks to the additional funds from HIPS:

Jadelle (long term family planning)

202

Safe medical male circumcision

308

Depo (short term family planning)

416

Mosquito nets for pregnant mothers

440

Mama kits for use during delivery

280

Sometimes of course it doesn’t work out and sadly in 2011, 17 of those enrolled on ART died from AIDS related conditions. These individuals joined our programme too late for the treatment to make a long-lasting impact on their infection. That’s why its important that we continue to conduct regular, community based, outreach in which we can provide health education and encourage people to come forward and be tested, before they start to feel sick.

The programme is, we think, a good example of how companies and agencies can work together, sharing cost, resources and expertise, to provide life-changing health services to those that need it most.

IMF Working with Kasese Cobalt Company Limited

For three years International Medical Foundation has been working with Kasese Cobalt Company Limited to provide basic health services to the poor living in three communities close to the KCCL facility in Kasese, West Uganda.

This programme has been supported by Health Initiatives For The Private Sector, a USAID funded project.

Together we have provided HIV voluntary counselling and testing to 2,925 adults, of which 560 tested positive. We have enrolled 444 onto our treatment and care programme and currently 136 are receiving anti-retroviral therapy, ART.

Those enrolled are able to have regular health checks, including a CD4 test which provides a clinical indication of the strength, or weakness, of their immunity system. When the CD4 count has fallen to a given threshold the client is then started on ART. They are provided with insecticide treated bed-nets to help prevent malaria, are screened for TB (those living with HIV are very susceptible to TB) and provided with family planning supplies.

Anti-retroviral drugs and test kits are supplied by the Ministry of Health, free of charge to the programme. The equivalent cost of these is about half of the total cost needed to the run the full programme. KCCL and IMF split the cost of staff, transport, facilities and, importantly, the cost of drugs for the treatment of opportunistic infections and CD4 tests. HIPS provides the bed-nets, family planning supplies, TB lab equipment and training for the clinical team and peer educators in the community.

The partners also, from time-to-time, need to meet the cost of buying ARVs when there are stock-outs and supply is not being provided by MoH. This is a key issue that must be addressed by such programmes and unfortunately one that may continue to get worse. It is inevitable that some rationing of ARVs will need to take place as only half of those that should be on ART are currently enrolled and being treated. This position would worsen significantly if Uganda was to adopt the most recent WHO guideline which recommends the start of treatment at a CD4 count of 350. We are still using the previous guideline of 250.

The programme is, we think, a good example of how companies and agencies can work together, sharing cost, resources and expertise, to provide life-changing health services to those that need it most.