Uganda’s sick health sector problem bigger than mere chemistry passes

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Patients at Apac hospital awaiting medical treatment. Credit: World Policy Journal

BY ALEX TAREMWA

In December 2014, my nephew Sheldon was admitted at Holy Innocents’ Hospital, one of the best children hospitals in Mbarara. He was anemic, dehydrated, and he had malaria that forced him to stare death in the eye.

When I arrived, I was ushered into the ward by a nurse who I later learnt was a Uganda Christian University (UCU) Nursing Science student doing her internship. As an alumnus, I left that day feeling safe; I knew my title of uncle would last a lot longer.

When I returned in the morning, I found the nurse babysitting and feeding the baby. Her conduct, discipline, competence and knowledge portrayed nothing short of professionalism.

It is possible that this young lady did not do or pass chemistry at A-level and even armed with her four-year hard-earned degree, the Uganda Nursing and Midwives Council (UNMC) will not register her for practice.

In principle that is the right thing to do, but does it solve Uganda’s health sector problem?

The Ugandan health sector has experienced challenges related to recruitment and retention of qualified staff, mainly due to low remuneration as well as insufficient career opportunities.

According to the Budget Monitoring and Accountability Unit (BMAU) in the Ministry of Health report, in 2010 there was a very low doctor to patient ratio of 1:24,725 and a nurse to patient ratio of 1:11,000, way below the World Health Organisation (WHO) recommendation  of 1:439 as the health worker to population ratio.

Worse still, maternal and infant mortality are still going through the roof, traditional midwives are still delivering babies with their rudimentary tools, clinics and pharmacies across the country are manned by nurses with three months’ training or even less – some reusing syringes for injections and getting away with it.

For Uganda to meet the minimum health standards, the number of health workers must triple.

Attention, therefore, needs to shift from cheap politicking to the core of the problem, which is poor composition of health professionals. According to the 2011 Human Resources for Health Audit Report, with respect to the national level staffing, the proportion of the filled approved positions was found to be only 58 per cent.

Out of the 55,063 approved positions, only 31,797 are filled, leaving 23,321 vacant positions. The situation is worse at the level of health centre IIs. Out of 4,905 posts in 1,321 health centre IIs in the country, only 2,197 (45 per cent) are filled.

I admit that there could be life threatening consequences arising from a health worker’s lack of chemistry knowledge or background, but I submit there are greater consequences from having none at all. Enough of the games, if UNMC lacks the guts to do the right thing; that is waive chemistry only for the degree holding nurses without it so far, for the sake of Ugandans, someone else should.

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Alex Taremwa is the  Managing Editor of The Transparent Magazine

Demystifying health challenges: Vitiligo

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INTERVIEW: Alex (me) interviewing Opeilo at his desk in The Standard office. Credit: Doreen Kajeru

On July 27, Andrew Opeilo turned 20. Though he was admitted at Uganda Christian University (UCU) to pursue a degree in Law, he always dreamt of being a pilot or a flight engineer.

However, while in Primary Seven at Shimon Demonstration School, he contracted an illness that, from a distance, would make people mistake him for an albino.

After thorough examination by experts, Opeilo learnt that he had a rare skin illness known as vitiligo.

Dr. Gerald Ssekitoleko, a dermatologist at Mbarara Regional Referral Hospital, explained that the skin contains melanin, a pigment that gives the skin, hair and the colour of eyes.

The Institute of Arthritis and Musculoskeletal and Skin Diseases estimates that about 0.5 to 1 percent of the world’s population has vitiligo.

Vitiligo is a disorder in which white patches of skin appear on different parts of the body.

This happens because the cells that make pigment (colour) in the skin are destroyed. These cells are called melanocytes.

“But if the melanocytes cannot form melanin or when their number decreases, the skin often becomes much lighter than the rest of the body, resulting in vitiligo,” he said.

Vitiligo may be an auto-immune disease. Such diseases happen when your immune system mistakenly attacks some part of your own body.

Researchers have also proven that injury, stress, traumatic events, or severe sunburns, may trigger vitiligo.

Many people develop it in their twenties, but it can occur at any age. The disorder affects all races and both sexes equally. However, it is more noticeable in people with dark skin.

Vitiligo causes disclouration in the skin’s upper dermis. Nonetheless, many people with vitiligo are healthy and have normal skin texture and sensation.

Opeilo joins colleagues for a group discussion at Uganda Christian University (UCU), Mukono

Opeilo joins colleagues for a group discussion at Uganda Christian University (UCU), Mukono. Credit: Alex Taremwa

Opeilo cites the late singer Michael Jackson’s skin disorder, saying he suffered from acute skin discolouration caused by vitiligo probably the reason he sought skin uniformity.

However, most people with vitiligo have no other auto-immune disease.

Vitiligo may also run in families. Children whose parents have the disorder are more likely to develop vitiligo.

However, some children will not get vitiligo even if a parent has it.

White patches on the skin are the main sign of vitiligo. These patches are more common in areas where the skin is exposed to the sun.

The patches may be on the hands, feet, arms, face, and lips. Other common areas for white patches are: the armpits and groin (where the leg meets the body) around the mouth, eyes, nostrils, navel, genitals, rectal areas.

The speed of the disease is intrinsic that there is no way to tell if vitiligo will spread. For some people, the white patches do not spread. But often the white patches will spread to other areas of the body.

For some people still, vitiligo spreads slowly, over many years. For other people, spreading occurs quickly.

Some people have reported more white patches after physical or emotional stress.

The choice of treatment depends on: the number of white patches, how widespread the patches are and the treatment the person prefers to use. Some treatments are not right for everyone. Many treatments can have unwanted side effects.

Treatments can take a long time, and sometimes they don’t work.

Opeilo, an aspiring lawyer has a fashion touch and great sense of humor. He is seen here posing for a photo after the interview. Credit: Alex Taremwa

Opeilo, an aspiring lawyer has a fashion touch and great sense of humor. He is seen here posing for a photo after the interview. Credit: Alex Taremwa

Current treatment options for vitiligo include medical, surgical, and other treatments. Most treatments however are aimed at restoring colour to the white patches of skin.

Medical treatments include: medicines (such as creams) that you put on the skin, ones that you take by mouth, a treatment that uses medicine plus ultraviolet A (UVA) light (PUVA), removing the colour from other areas so they match the white patches.

There are surgical treatments too such as skin grafts from a person’s own tissues. The doctor takes skin from one area of a patient’s body and attaches it to another area.

This is sometimes used for people with small patches of vitiligo and tattooing small areas of skin.

Other treatments include: Sunscreens, cosmetics, such as makeup or dye, to cover the white patches.

The main goal of treating vitiligo is to improve appearance. Some people with vitiligo have found that cosmetics that cover the white patches improve their appearance.

“People will look at you with curiosity but God has a plan and he doesn’t make mistakes. No one can define who I’m. It all comes down to knowing and loving oneself,” Opeilo said.

Heavy Facebook Use Makes Some People Jealous And Depressed: Study

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Paying too much attention to your Facebook friends’ updates could be bad for your mental health, according to a new study.

Researchers found that heavy Facebook use may make certain people experience feelings of envy, which in turn could lead to depression.

“We found that if Facebook users experience envy of the activities and lifestyles of their friends on Facebook, they are much more likely to report feelings of depression,” study co-author Dr. Margaret Duffy, a University of Missouri journalism professor, said in a press release. “Facebook can be a very positive resource for many people, but if it is used as a way to size up one’s own accomplishments against others, it can have a negative effect. ”

The study surveyed 736 college students from a large Midwestern university who used Facebook for an average of two hours every day. Seventy-eight percent of the subjects identified as white Americans, and 68 percent identified as female. Their average age was 19.

These participants filled out a survey indicating how much they use Facebook and what they do on the social network. They were also asked to rate how much they agreed with statements linked to feelings of envy, such as, “I generally feel inferior to others,” or “It somehow doesn’t seem fair that some people seem to have all the fun.” Then, participants rated how much they agreed with phrases that corresponded to depression, such as, “I was bothered by things that usually don’t bother me” and “I talked less than usual.”

The researchers found that while heavy Facebook use was not linked directly to depression, frequent users who experienced feelings of envy were more likely to identify with statements corresponding to depression. These tended to be users who compared their own lives to friends’ photos of luxurious vacations, status updates about good news and so on.

This study is far from the first to examine how Facebook impacts the psyche. Research from last year suggested that the longer people spend on Facebook, the worse they feel. Other studies, such as one from earlier in the year, found that time spent on the social network might actually make people happier.

“In social science, we build on each others’ work and findings and don’t claim that a single study can establish causal relationships,” Duffy told The Huffington Post.

The results from this new study aren’t all doom and gloom, though. The team found that users can avoid feeling bummed out by the social network as long as they’re mindful about how they consume information from it.

“Users should be self-aware that positive self-presentation is an important motivation in using social media, so it is to be expected that many users would only post positive things about themselves,” study co-author Edson Tandoc said in a press release. “This self-awareness, hopefully, can lessen feelings of envy.”

The research team published its new paper in the February edition of the journal Computers in Human Behavior.

Lemon Grass: Something that shouldn’t miss in both your garden and kitchen

I leave home very early in the morning and as most of you know, I’m not married so I don’t have breakfast at home. However, there is a Café in town that serves me Lemon Tea every morning even when I live in the so called land of milk and honey; Mbarara.

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This morning as Marvin can testify, I felt the urge to share with you the benefits of sipping a cup of lemon tea each morning both physically, mentally and health wise but first, let me tell you what lemon tea/grass is all about.  I used Marvin because it’s his prerequisite that I carry this overwhelming tea ingredient every time I’m going to his house. In other words he has not only read about it but also he’s fan. 

There wasn’t a complete herb garden when I was born at least here in village during my life’s early days unless it contained te-de-limon, or lemongrass. Then, over the years, the plant, like so many other sources of natural drinks and “cures,” slowly faded from use and cultivation. Today’s renewed and still-growing interest in herbs and herb teas, however, is now bringing te-de-limon back once again: For the first time in years, dried lemongrass is being sold and purchased in health food stores throughout the country.

Although there seems to be little scientific basis for the claims, Folks in medicine hold that the benefits of lemongrass tea include: aiding digestion, calming nervous disorders and helping in the treatment of high blood pressure. Cymbopogon citratus as the plant is known to the botanist is also cultivated and distilled in Java, Ceylon, Malaysia and Central America for its oil (which is used in pharmaceutical preparations and skincare products).

Furthermore, according to Dorothy Hall’s The Book of Herbs, lemongrass contains vitamin A and is good for “those who wish to have bright eyes and a clear skin.”

Well, I can’t vouch for those claims, but I do know from firsthand experience that Cymbopogon citratus is a perennial grass that can be grown either in the garden or as an indoor (or outdoor) potted plant. It thrives in warm weather (it does not do well in extremely cold climates), grows from two to four feet tall, and  when used as a background for other plants can add a tropical touch to the garden.

Lemongrass seldom bears seeds and is almost always propagated from a section of root. That propagation, however, is easy: The plant thrives on nothing more than a sunny spot, rich soil, and plenty of water.

Just as its name implies, lemongrass easily brews up into a delightful, lemony-flavored tea. Cut several long blades of foliage from the plant, wash them, and chop them into inch-long pieces with a pair of scissors. Then cover the bits of grass with water, bring the liquid to a boil, and steep for 10 to fifteen minutes.

Or if you prefer, you can place the cut-up foliage in a heated teapot, pour boiling water into the container, and steep until the resulting tea is as strong as you want it. Sweeten the hot drink with honey, or chill the tea and serve it cold.

I’m one of the growing numbers of devotees who think that lemongrass tea has a never-to-be-forgotten flavor. It was the memory of a “long ago” cup of the drink, in fact, that recently made me set out to purchase a Cymbopogon citratus for my garden in Kazo, Kiruhura. Imagine my dismay when I learned that no local plant nursery offered lemongrass for sale.

Email: alex.taremwa@yahoo.co.uk

HEALTH: How to get rid of Dead Skin

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By Alex Taremwa

According to The Boston Globe, 30,000-40,000 skin cells fall off you per minute, and on average 8.8 pounds of dead skin cells fall off your body per year.

Your body sheds dead skin cells on a constant basis. A good example is your feet, legs. If your skin is dry, you’ll actually see flaky skin cells that are easy brush off; those are dead skin cells.

The good news is dead skin can be prevented, cleared and avoided and in this article, Dr. Grace Kamwebaze; a skin expert at the Mbarara Regional Referral Hospital Skin Clinic explains steps through which this can be achieved in reference to an internet article titled “How to get rid of Dead Skin.”

These 8 steps elaborate the application, items and mechanisms through which an affected undergoes in order to get rid of the slow but considerably sure illness. They include:

Keep a bottle of hand lotion at each of your kitchen and bathroom sinks and apply after each wash. This helps to keep your skin moist at all times thereby impossible to break or tear.

“Our hands tend to be one of the most exposed parts of our bodies, and they deserve protection,” Grace explains. The doctor maintains that people should wear gloves in cold weather, especially if they engage in outdoor activities such as jogging or biking.

For chapped lips, use Chap Stick, Vaseline or lip balm. Again, dry lips are most common in the cold weather. You may wish to apply Vaseline before you go outside.

Note: It is commonly believed that lip balms are addictive. While habitual use of Chap Stick does not lead to physical dependency, because lips are generally very sensitive parts of our bodies, lip balms can be psychologically addictive.

When bathing; endeavour to swap the scrub brush for a wash cloth. Soft wash clothes can be just as cleansing, and are a lot easier on your skin. In addition, excessively hot water, though perhaps relaxing, strips away essential oils from your skin. Always keep your water temperature reasonable.

“When Shaving, shave down, not up; in other words, shave in the direction of your hair, not against it. Use shaving gel with natural moisturizers such as aloe, rather than those that contain alcohol,” he added.

Other recommended remedies can home basic and nutritious in nature. They are easy to access and less costly. These are:Image

Olive oil:  applying a thin layer of olive oil under your moisturizer can adjust the extra touch of fats and protective amino acids that you need. Honey also keeps the libs soft and smooth. In that case, apply a light layer of honey to your lips before you go to sleep. Honey can also be used to help heal cracked elbows and rough heels as well.

Sugar and oil: Combine equal parts brown sugar and any household oil for a highly economical, highly effective skin scrub. Add a tablespoon of honey and a few drops of lemon for extra nutrients. Smear the solution to the affected area often times and within a short while, you will have started noticing results.

 “Most people grow Aloe (Rukaka) in their homesteads.” So purchase an Aloe cactus, and place it where it will get plenty of sun. Break open a leaf once a week, and apply a layer of sap to your skin for 15 to 30 minutes.

 When it comes to foods, Yogurt, papaya and pumpkin do it best. Like many other items in your typical dairy and produce aisles, yogurt, papaya and pumpkin can be highly effective exfoliants when mixed with a few key ingredients, and applied to your face or body as a mask.

“Remember, you are what you eat, so eat right. A diet rich in vitamin C, Magnesium, essential fatty acids and beta-carotene will help supply your skin with the bodily defences it needs,” Grace emphasised. Always employ a meal plan that includes dark chocolate, fatty fish, carrots, and fruits such as mangoes and oranges.

 

 

 

 

World Aids Day: Mbarara District looks forward to a generation free of HIV Babies

By Alex Taremwa

On the 1st of December, Uganda will join the international community to mark the International World Aids Day, a day when unity and support is accorded to people living with the incurable virus and commemorating those who have died of the same.  As one the districts labeled as high risk of infection areas, Mbarara District was selected to host this phenomenal event with the theme “Getting to Zero.”

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Where Mbarara District in as far as HIV/AIDS is concerned?

Mbarara District is located in the South Western Uganda. It is located at a surface altitude of 1800metres above sea level with a surface area of 1846 square kilometers. The District is made of two countries and one Municipality, 14 Sub-Counties and 3 divisions, 77 Parishes, 6 wards, 716 villages and 52 cells in the Municipality and it is served by 5 Hospitals, 5 HCVs, 11 HCIIIs, 34HCIIs and over 250 primary schools. The District population stands at 457,950 with an average growth, rate at 2.9%

The threat from HIV/AIDS remains acute countrywide as over 2 million people have been infected since 1982. Every day, about 300 cases are reported daily amounting to an undisputed 130,000 infections annually.[i]

In Mbarara alone HIV/AIDS contributes to at least 9.1% of the total disease burden as its prevalence in people aged between 15-49 is estimated to be between 5.9-6.1 in 2005-2011 respectively.

Mostly the urbanites suffer much of the problem as shown by a Research on HIV/AIDS that has been conducted in three hotspot areas of Kijungu, Nyeihanga and Ruti in Mbarara that showed that the prevalence is at 12.6 per cent two times higher than the general prevalence in the district at 6.1 per cent and far above the national prevalence of 7.3 per cent.

Their rural counterparts on the other hand have their prevalence estimated between 2-3%, 8% in pregnant mothers and in every 100 new born babies, at least 1-3 are born with the virus in the district where at least 60% of the total population know their HIV status.

If the trend isn’t reversed, it’s projected that within a period of 5 years, there is likely to be 700,000 new HIV infections and at least 250,000 in new born babies countrywide.

According to Dr. Umar Masereka a lead HIV/AIDS Focal person for Mbarara District who also is the District Health Inspector, the rise in the prevalence of HIV/AIDS in the district and nationwide at large can be attributed to three major factors:

  • Limited Focus on Sexual Behaviour
  • Reduced solidarity and commitment amongst stakeholders
  • Lack of a direct communication for behavioural change.

 

Masereka told Daily Monitor that the key drivers behind the rise of the epidemic in Mbarara are most geographical and cultural in nature.

“There are some of the busiest spots in the district with many bars and lodges and are frequented by trans-boundary travellers. Kizungu in Kakoba Division has many bars and lodges patronised and frequented by prostitutes, Ruti suburb in Nyamitanga Division is a station for truck drivers on long routes to DR Congo, Rwanda and Burundi whereas Nyaihanga trading centre located about 30 kilometres on Mbarara Kabale-road is frequented by local and international coffees, fish, sand and matooke traders,” he told Daily Monitor in a recent interview.

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Where in Mbarara can one get HIV/AIDS services?

Unlike other areas, Mbarara is sophiscated in as far as accessibility to HIV, Counseling and Testing (HCT) services are concerned. In the entire district, at least 5 Hospitals, 4HCIVs, 12HCIIIs, 14HCIIs and 8 NGOs Health units offer counseling and testing services.

In addition to the above listed, people can also access ART services from 5 Hospitals, 4HCIVs, HCIIIs in Nyakayojo, Mwizi, Ndeija, Bukiro, Biharwe Kagongi, Rubaya, Bubaare, Rubindi Kakoba and Nyamitanga.

However not all the above mentioned offer ABC plus (HCT, PMTCT & Safe Male Circumcision services). In fact a research conducted in 3 key hotspot areas in the district by the Makerere University School of Public Health indicated that of the 245 respondents; 78, 87 and 80 in Kijungu, Ruti and Nyeihanga respectively, only 33% are circumcised whereas at least 62% were willing to get circumcised had they had access to the services.

The study also shows that of the respondents interviewed in the three Priority Prevention Areas (PPAs), 82% of them had good knowledge of where to go for an HIV/AIDS test and that indeed 76% of them actually taken at least a single test in the last 12 months.

Despite this sophiscation, Mbarara District faces challenges ranging from inadequate funding, derailed condom use and growing transactional sex ignited by the large urbanisation that transpires in the Central Business District.

According to a Makerere Joints Aids research Program (MJAP) on Mbarara, 29% of the respondents interviewed had ever received a gift or favour in exchange for sex, 26% had received help with expensed in exchange for sex, at least 24% had ever received cash in exchange for sex and at least 32% had ever paid cash for sex.

Condom Use:

Whereas condoms are an inseparable component of an HIV/AIDS prevention mechanism, they are increasing becoming unpopular amongst the sexually active Ugandans with some claiming they are inefficient while others say they Uganda has taken a step in the right direction in attempt to cub the raging virus. But the question is; have we?

68% of the sexually active respondents interviewed confessed to using condoms occasionally whereas 21% confessed to not using condoms at all. Only 11% of the respondents agreed to having used a condom consistently and correctly every time they had sex.

When asked if accessibility to condoms was the reason for the inconsistent use of the protective mechanism, 84% of the respondents declined saying that it was easy for them to get a condom with only 18% of the sexually active respondents accepting that indeed condom access to them was a very big challenge.

One of the respondents Akampwera Kenneth who consented to an interview with the Daily Monitor said that condoms reduce his effectiveness in bed rendering him boring and irrelevant to his partner.

“There are some sex styles that one just can’t do with a condom on. I would rather be faithful that go in with rubber,” Kenneth said.

Other challenges that the district faces in terms of fighting HIV/AIDS are;

  • Lack of focused programmes for youth in and outside school (secondary schools)
  • Low male involvement in the PMTCT programmes.
  • Increasing members of OCVs, Vs decreasing numbers of funders.
  • Inadequate funds to fill gaps in the HIV/AIDS response
  • Lacks of CD4 machines in the rural counties.

Future plans:

The key district focus is to a zero HIV baby infection somewhat related to this year’s World Aids Day theme “Getting to Zero”.  And according to the District Health Officer Dr Amooti Kaguuna, strategies have already been designed on how to achieve this grand long term plan.

Among these are; strengthening PMTCT by recruiting more personnel in the health sector, scaling up HCT services to at least all the Parishes in the district, designing campaigns for male involvement and increasing accessibility to condoms through effective consistent supply of condoms to community outlets.

The district also plans to improve efficiency and effectiveness of HIV/AIDS service delivery by improving logistics management, strengthening and scaling up the school based and student led HIV/AIDS initiatives in addition to strengthening treatment and management of HIV/AIDS including ART up to Health Centre III and establishing a comprehensive care system for children with HIV/AIDS.

Dr Amooti also added that he believes that strengthening home based health care services for people living with HIV/AIDS, economic empowerment of people living with HIV/AIDS through agriculture, provision of economic and material assistance to people affected and infected with HIV/AIDS, strengthening district capacity to co-ordinate, monitor and effectively respond to the HIV/AIDS pandemic are key bottlenecks to achieving the district objectives although the district hasn’t accumulated enough resources to undertake them at once and it’s looking up to donations to implement them.

“But by and large, the district is doing well.  We just need to consolidate our gains so far and strengthen Quality and access with special focus on prevention and systems strengthening,” Dr. Amooti said.

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Rabies kills 6 in Kiruhura District.

ImageBy Alex Taremwa

Residents of the Kiruhura district are trembling in fear as rabies infested dogs have bitten and killed 6 people, with 2 others currently in critical condition.

The horrific death of an 11-year-old boy on 19 Oct 2013 in Meru-Meru, a village in Nkungu Sub-county, brought the total number of deaths related to rabies to 6 within 5 days. According to an eyewitness, when the boy was brought to Buremba hospital, he was literarily barking like a dog and acting hostilely.

He said that because the case had advanced, the medical personnel could not offer any help except to dose him with tranquilizers just to ease the pains. His parents, out of frustration however, took the child home, where he died later the same day.

According to a health official, 2 people from Kitamba, a border community in the district, reported with cases of rabies on 20 Oct 2013 but were asked to go and buy the drug (vaccine) from Ibanda for treatment. The victims could not afford the drug and so had to return home to await their painful death.

According to the official, anti-rabies vaccine sold in the open market costs around Ushs 175,000, an amount too costly for most people living in deprived communities such as Buremba. An official at the hospital who pleaded anonymity alleged that because the vaccine is expensive, some officials are hoarding the drug as a way of making money for themselves.

Rabies is an acute viral infection that is transmitted to humans or other mammals usually through the saliva from a bite of an infected animal. It is also rarely contracted through breaks in the skin or contact with mucous membranes.

According to the Control of Communicable Diseases Manual, all mammals are susceptible to rabies. Raccoons, skunks, foxes, bats, dogs, coyotes and cats are the likely suspects. Other animals like otters and ferrets are also high risk. Mammals like rabbits, squirrels, rodents and opossums are rarely infected.

Dr. Moses Mutiikuuzi, a professional veterinary doctor explained that the symptoms of rabies are as follows. Initially, like in many diseases, the symptoms are non-specific; fever, headache and malaise. This may last several days. At the site of the bite there may be some pain and discomfort. Symptoms then progress to more severe: confusion, delirium, abnormal behavior and hallucinations. If it gets this far, the disease is nearly 100% fatal.

“The only treatment for human exposure to rabies is rabies-specific immune globulin and rabies immunization,” he said.  Appropriate treatment started soon after the exposure will protect an exposed person from the disease.

Never should expectant mothers deliver in bushes again

ImageIt is 10:45 am and everybody is on his/her station duty busy attending to patients in Nyamuyanja Health Centre in Isingiro district. The Centre is packed to capacity because the health workers are available to the patients despite the challenges they face.

In 2008 exactly at the same time a lady had come to deliver her third child from the same health Centre but nobody was there to attend to her because the in charge doctor was not present, he had gone for further studies.

His deputy had not yet reported for duty and the ambulance which was supposed to take her to Mbarara referral hospital had no fuel, besides the driver also had not reported.

 The only alternative available for this lady was to deliver in the bush nearby and it made headlines in the local media. The embarrassing incident happened in the very eyes of the head of Millennium Development head at the UN Prof Jeffry Sucks and the then state minister for planning Omony Ojok (RIP) who were on fact finding mission of how to expand the millennium villages’ project into the whole country.

 It also moved some of the medical staff in the country and ended up landing a committed female doctor to move from the comfort of Kampala to this rural health center.

Dr Doreen Kenyangi moved from Mengo Hospital to come and work in the rural Nyamuyanja HC4 and has since turned this death trap to a functional Centre.

Dr Kenyangi says she is driven by passion and has not focused on money because she believes she can make money anytime she feels she wants. She says she is still young and can get employment anywhere in the world.

“After reading the story in the media I was moved and vowed that this should not happen again and the only solution was to go to that particular Centre. I also moved from Kampala to satisfy my ambition of serving the local people as a medical doctor. To me becoming a doctor is a calling and my target is not money because I can always make it” she says.

Since her arrival about a year ago, the situation has improved tremendously as the population has regained confidence in the services of the Centre it offers. Every day about 200 out patients visit the facility and most of them pass through her hands.

The number of inpatients has also increased from about 5 to 40 and mothers delivering at the Centre have increased from 10 to 40 per month.

After that big embarrassment government patterned with Ruhiira Millennium Villages Project (RMVP) and Medical Team International (MTI) to revamp the Centre and some of the bottlenecks have been worked on.

Dr Gerald Mutungi the program manager non communicable disease and special permanent secretary Isingiro district says government has moved in to solve some of the bottlenecks in the health Centre 1V’s in Isingiro district like having constant supplies of drugs, making the theatres operational and provision of a generator for each health centre.

“With the help of partners we have been able to operationalize the two theatres of Nyamuyanja and Rwekubo Health Centre 1Vs in the district and fully equipped the delivery rooms for the expectant mothers with new delivery beds and enough drugs for the expectant mothers,” he says.

 Joyce Unimana, 22, who was the first to have an operation at Rwekubo Health Centre 1V  was  overwhelmed by the treatment.

 After the tragic loss of her three babies in a row before, couldn’t control her emotions when health staff presented her with her newborn son, following an emergency cesarean section. “I am extremely happy to carry my son.” Joyce exclaimed. “I have sad memories after losing 3 babies.”

During her third pregnancy, Joyce had managed to get to Mbarara referral hospital, but the baby was dead by the time the surgeon could operate. “This baby is so precious to me,” Joyce continued. “My husband divorced me because I had no child, but holding baby Samuel in my arms brings so much joy. I can now be called ‘mama Shukuru’. He is called Shukuru Samuel.”

 

The head of medical services RMVP Dr Emmanuel Atuhairwe says the project has stepped in to help the government through improved maternal and child health services, management of antenatal and postnatal care, family planning and obstruct cases.

“To decongest the health centers, we are aiming at taking maternal health services from health center 1Vs to heath center 11s to be able to handle maternal and child health services and to strengthen the referral system from the peripheral health centers to health center 1Vs in Isingiro district ” he says.

This is to bring it in line with other health centers in Nyakitunda and Kabuyanda sub counties where RMVP is operating and has largely succeeded. The referral system has been strengthened with the provision of ambulance to manage complicated cases that are referred to higher centers up to Mbarara referral hospital.

He says the project has also strengthened the village health teams through trainings and support supervision to provide basic care at household level, diagnosing and treatment of malaria in children less than five years, improvement of personal hygiene, diarrhea and simple pneumonia among others. 

However Dr Kenyangi says despite the shortage of staff, lack of furniture, electricity, staff housing and lack of blood progress has continued to be made.

Despite delivering some babies at night, restituting children using torchlight, mothers have gained confidence in the health centers and since the theater began operational 13 caesarian deliveries have been handled safely and reduced the referral cases to Kabuyanda Health Centre 1V. Her resolve to work in the rural area has inspired some of the medical staff who have emulated her. Ms Pulkeria Kyasimire a midwife handles antenatal, postnatal and deliveries alone while at the same time she carries out immunization.

“I have been inspired by Dr Kenyangi to work hard to save mothers lives. For the last two weeks I have been managing the whole department of mothers and children because my workmate is sick and I cannot complain”, she said.

The district health officer Dr Edson Tumusherure says some of the bottlenecks the health centres are facing are crosscutting in the country.

“We find it very difficult to recruit and retain staff because of various reasons including poor pay and doctors shunning to work in rural areas opting for greener pastures”, he says.

He says blood shortage in health centres especially those that carry out operations is a serious problem that needs immediate attention and arrangements have been made with blood bank of Mbarara to supply these centers with Blood. “We are looking for fridges where to keep the blood to save any complicated cases that may arise during operations”, he says. Other challenges include lack of enough beds for mothers’ delivery and in wards. Some patients sleep on the floor while others share beds.

Dr Kenyangi is optimistic that with commitment from doctors the situation of expectant mothers can improve tremendously and is determined not to see mothers delivering from bushes again when doctors are available to avert the situation especially herself in the area where she operates.