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Thursday, December 30, 2010 - Nkondo

By Shelly Tregembo

This afternoon, while the rest of the health team ventured into Kamuli to the Health Centre 5 to transport a couple of patients, Annslie, Philippe and I set up a meeting with the Women's Rotary Community Corps (RCC).

Interestingly, we discovered that the "Women's" RCC is actually composed of 10 men and 10 women. One of our hosts, Frances, explained that by excluding the men, they were worried about creating conflict that would be detrimental to the operation of the group so they have allowed them to participate as well.

As the time drew closer for the start of the meeting, we looked around the yard and noticed that there were several people showing up in yellow t-shirts. Apparently, the Youth RCC had caught wind that we planned on giving a training and decided they didn't want to miss anything!

The RCCs are critical community partners in terms of providing outreach to the village. These groups are supported and mentored by the Rotary Club of Kampala North and in addition to being a liaison to the community; they also try out new farming and enterprise techniques. They are motivated groups who are eager to help. In addition to the Women's and Youth RCCs, there is a third group of disabled individuals who are working on developing a beekeeping business.

At the training this afternoon, I worked with the RCCs to develop an understanding of the importance of latrines. We went around the group of about 25 members and each of them shared reasons why they think some people don't have latrines. Some of the ideas included ignorance, stubbornness, dislike of government, having plenty of land to use and laziness. What I found very interesting is that not one single person mentioned money as an obstacle. I asked the group if they would be willing to talk to the community to discuss the value of having latrines. They all agreed and decided that they would like to go door to door to spread the message. With that in mind, I did some basic health education regarding the benefits of having a proper latrine with a cover and then I decided it would be a good idea to do a skit. I took a volunteer from the audience and I played the part of "reluctant villager" while she set out to convince me that I needed a latrine. I pulled out all the stops including the fact that my husband a other wives and didn't seem to have time for things like latrine building. Jen, the volunteer, convinced me that I didn't need a husband to dig a latrine and that if I needed help she could help me to figure out what to do. I agreed and told her I'd start tomorrow!

After discussing latrines, we also review basic nutrition and malaria prevention. Annslie came prepared with laminated cards that she will provide to the school which have pictures of the right and wrong way to do things as well as food groups. The group enjoyed reviewing the cards and we assured them that we were not only asking for their help, but we were also providing training to the teachers to start spreading this information to children as well.

At the close of the group, we thanked them for their interest and participation and Philippe gave them some guidance regarding how to go about organizing their outreach. He suggested that they make a list of all of the individuals who they know who do not have latrines and begin to divide the list among themselves for coverage. They seemed very responsive to this sort of direction which made a little light bulb go off in my head- training opportunity!!! If time permits, I think some planning assistance may be a great benefit to the RCCs.

Thursday, December 30, 2010 - Kamuli

By Amanda Wirtz

We departed early in morning for the Health Center 5 Hospital in Kamuli (40 km away) - anticipating an opportunity to experience first hand, the highest level of government-provided healthcare in Uganda. We also anticipated an opportunity to potentially support the healing of several community members - specifically two children named Tabitha and Joseph. Even providing a ride to the hospital was a gift to the families since they lack access to transportation; a roundtrip voyage on a boda-boda (motorcycle taxi) costs approximately 10,000 shillings - a week's worth of labor.

Tabitha's family stopped our vehicle on our homeward voyage just days before. Propped up, sitting timidly on the bumper of Patrick's vehicle - Joanna led the way in a rather rudimentary inspection. Geoff, Joanna and I all donned rubber gloves as we investigated her inflamed, seemingly infected arm. As we probed her family for a health history, we discovered that this 10 year old girl's condition had been worsening over the course of six months. Her family reported that they had taken her to the doctor previously; they were advised that she would likely require an 'expensive' surgery they could not afford (costing 50,000 shillings = $25) and that the child would likely be lame as a result. With a terrified expression, her mother (with numerous other children in tow) pleaded for our assistance. To empower the family to take joint responsibility for Tabitha's health, Patrick suggested that if the family could gather the funds, we would see that the child would be taken, and supported, in being seen at the Health Center 5 (the main hospital). The next day, Tabitha and her mother (Rose) walked several kilometers to Patrick's house with 50,000 shillings in hand.

Joseph, a rather meek six year old boy, arrived at Patricks house with his concerned father several days before as well. Some ailments are universal - especially when it comes to children. Joseph had implanted a small pea in his ear. Lodged deep in the ear canal, Joanna - with simplistic tools on hand - was unable to retrieve the offending agent. We took turns holding and calming the small boy as she repositioned herself relentlessly in attempt to free the pea. Several pair of tweezers, a headlight, an eye dilating light, and the promise of a candy cane was simply not enough; the boy needed to go to the clinic as well. Recognizing our plan to visit the Health Centre 5 with Tabitha, we suggested that Joseph join us as well. The prince would be free from his pea. - or at least we would make our best attempt to make it so.

Fred, our forever friend/ translator/ driver joined us as our 'patients', their parents, and the health team (Joanna, Geoff, and I) ventured out for the hospital. After hearing that we were likely to receive maximum support by simply being 'white' and with professions in health, we staged our team as effectively as possible - in scrubs. Call it hokey, but also call it effective. Immediately upon arrival, we were approached by the director of the hospital who guided us (and our ailing patients) to the head of a very lengthy line where both children were given an initial evaluation and a plan of action.

Joseph's father was directed to purchase (at the hospital) a syringe for his son. Initially we were told that the syringe would be used to sedate the boy so they could calm him enough to remove the pea. After guiding the boy into a small 'surgery' room, he was placed on a stool - his head tipped to the side. A medical assistant of sorts removed the needle tip from the syringe and filled it with water from a water basin. In frustration, the assistant threw the syringe across the room; it was the wrong size. He picked up a used syringe plunger and rinsed it out. A weathered physician, with a hand crafted cane, walked into the room and, within minutes, used the syringe to flush out the boy's ear and dislodge the pea. The boy was free. The doctor began walking out of the room but paused and slowly turned toward the boy. As he relaxed his cane and his posture, he leaned in; with the pea in his hand, he sternly counseled the boy. With eyes turned downwards, the boy received his lecture. Although I don't speak the language, I recognize a 'talking to' when I see one. I imagine his lecture to be a somewhat simple elaboration of the message that 'peas don't go in your ear'. His father was pleased as were we. No crying. No sedation. No problem.

Tabitha's situation was not so straight forward. Joanna had previously, and quite miraculously (despite very limited internet connectivity) managed to match her condition with a photo found online. Patrick, being overcome with joy declared himself as 'speechless'. We all celebrated Joanna's succinct findings. Tabitha's condition appeared to be Mycetoma - a fungal infection often caused by contact with affected acacia trees which are highly prevalent in Africa. The spread of the likely infection was rather severe - affecting her mobility and causing widespread pain. If it was a fungal infection, it could be treated with medication; surgery and lameness would not be a likely outcome. We awaited the direction and input of the HC 5 physicians. After a visit to a rather rustic laboratory (where pathology slides were sun-dried in the window - and supplies were sparse) for a protocol HIV test, we were directed to pediatric orthopedics for a physiotherapist evaluation. We concluded our visit with a head nurse who refused to make the diagnosis independently. At this point, we had hours to digest the full Ugandan hospital experience.

We waited. And waited. And waited some more. The pediatrician we were awaiting was in surgery (also called Theatre). As we peered around at the rudimentary surroundings, I could only wonder what surgical arena would entail. A mother with a malaria infected infant approached us. The baby, weakened from infection was highly dehydrated and appeared to be in agony; she sagged in her mother's hopeless arms. Her mother kneeled down in front of us as to ask, without words, for a miracle we could not provide. We were afforded a room where we waited with Tabitha and her mother. Hundreds of others were not so fortunate. They lined the hallway floors - some hooked up to IVs, others clinging to shade where they could find it - all with a spirit of helplessness.

That helpless is unfortunately widespread in the Ugandan healthcare culture. Even though services may be theoretically provided by the government, many people do not feel empowered to ensure those services are actually provided and that they quality of those services is adequate. As a result, they often do not receive care and the care they do receive is substandard. We were nearly ushered into this phenomenon. The staff, after hours of waiting, informed us that they were not sure when the pediatrician would be available and suggested that we return the next day. Recognizing that hours and even days could be absorbed into this process, we pressed forward and assertively sought out a response from the physician; we were not leaving!

While a nurse apprentice flirtatiously engaged Geoff in conversation, Joanna and I sang songs to Tabitha and Rose. Recognizing they could not understand English, we felt at liberty to sing anything melodic that we could both recall; our selections included Stevie Wonder's 'My Cheri Amor' and a Christian song entitled 'If You Want Me To'. In response, Rose prompted her to return the musical favor. She bashfully rejected; for us, her smile was enough.

I inserted an earbud from my Ipod in each of their ears and they bopped back and forth to my favorite playlists. It was amusing to say the least to see these villagers enjoying their first electronic media experience.

On the clinic wall - scribed on construction paper - hung the 'Ten Guiding Principles to Good Management'. We were fascinated by #7 which read: Be Transparent, Efficient and Accountable - Truth, Fairness, Build good will and better relationship, benefit for all concerned. The Four-Way-Test had apparently made its way (at least in theory) to Kamuli Hospital!

The pediatrician finally arrived and, after a short introduction from our team, made his diagnosis. Mycetoma - just as Joanna had suspected; we were more than encouraged. He wrote a prescription for several medications and we were on our way! The first 'pharmacy' we visited did not carry the drug. The second pharmacy began counting the pills for sale. A strange feeling came over me - a prompting to look at the medication box.....expired. We rejected the medication and made our way to a third pharmacy where we finally found success. Tabitha's total healthcare bill came to 14,000 shillings -$7.

Here is a video story about Tabitha:

After a rather lengthy voyage home, packed in a sweaty, dirty vehicle crammed with people and produce (and meat!) purchased from town - we rested momentarily before attending to Tabitha's medication. Her family is illiterate - so we creatively concocted a method of communicating dosage and medication timing based on pictures and symbols. The young boy and his father happily departed. Tabitha and her mother, with medication in hand, walked in the dark with a light that reflected a new hope.