Wednesday, November 15, 2006

Bwindi Community Health Centre


Bwindi Community Health Centre was established by American Missionaries Scott and Carol Kellerman in 2002, to bring healthcare to the Batwa Pigmy Community. The Batwas are traditional hunter gatherers displaced from their natural forest home by the incursion of agriculturalists and by the creation of the national parks. These people now live in extreme poverty with no culture of food growing and no means of earning an income. Childhood mortality is 60%. Scott has created a charitable foundation that works with the Batwa people to provide housing, sanitation, water and schooling as well as providing health services.
The health centre has in patient facilities for adults and children, a busy outpatient department, an antenatal clinic as well as an immunisation programme. In-patients are mainly children with severe malaria or with malnutrition.
Paul and Vicky are two VSO volunteers who have been working at the centre since Easter this year. They have worked hard to introduce professional standards of care with clear protocols for the management of the common conditions. There are regular teaching sessions and staff meetings. The service is currently run by a medical officer, 2 clinical officers (nurse practitioner equivalent) and 5 nurses. There are basic laboratory, Xray and ultrasound facilities and hopes to open a surgical unit next year. Proactive HIV screening starts on December 1st (world AIDS day) and access to ARVs will come soon.
The annual running cost is currently about $200,000 of which half comes from charging the non Batwa users of the service and half comes from funds raised by Scott mainly in the USA. (Currently TB treatment, feeding of malnourished children and HIV testing are free. The Batwa community have a completely free service).
Scott is now spending half the year in Bwindi and half the year raising funds in America.
Compared to the other services we have had experience of since we’ve been in Uganda this service is excellent. (Remember it is common for there to be no drugs, no IV fluids, routine laboratory tests unavailable, poor medical care, non-existent nursing care).
We spent our week either on the ward or in the outpatient department. On Friday we joined Vicky and Paul at an outreach clinic in a Batwa village, 40 minutes from Bwindi. King, the manager of one of the local tourist camps brought a few of his staff for crowd control and to act as interpreters and we rattled through 80 people with an assortment of problems including coughs, colds and fevers.
We were well looked after in the guest house at the centre and had the good company not only of Paul and Vicky and the permanent staff at the centre but also of a couple of Danish medical students and Steve from Lake Tahoe who has been working as a general handyman here for the last 3 months.
Paul and Vicky are facing many challenges. Good timekeeping, regular ward rounds and teaching sessions and good record keeping depend on their continued presence and tend to slip when they leave Bwindi.
BCHC has up to now had a hand to mouth existence. It is very dependent on funds raised by Scott. When Scott isn’t around cash-flow can be problematic. Paul has taken to schmoozing with tourists visiting the national park to raise funds for important new projects (very successfully). A VSO volunteer is coming for 3 months in the new year to establish a formal accounting and budgeting system. Paul is also setting up a ‘Friends of Bwindi’ group, who he hopes will make regular financial contributions and provide regular income. One of the financial challenges is the extent to which the centre develops as a mini hospital. The current limited x-ray and ultrasound facilities are expensive to run and of dubious priority given the low immunisation rate, poor access to antenatal care and high incidence of the big killers – malnutrition, malaria, TB and HIV.
The establishment of a surgical unit will impose further financial strain on the centre. Whilst it makes sense to offer caesarian sections when maternal mortality is currently so high and the transfer time to the nearest surgical facility is 2 hours it will involve large revenue costs with surgical, anaesthetic and nursing staff as well as equipment and supplies. Paul worries that high cost interventions that help the few will limit the organisations capacity to make low cost interventions that help many more people such as community education, vaccination, antenatal care and family planning (a familiar tension in all health systems).
We were enormously impressed by the health centre and by the work Paul and Vicky are doing. This is a well organised, corruption free project. Within the confines of a low resource setting the health centre is providing extremely high quality care. Paul has identified improvements in maternal and child healthcare, and reducing the very high mortality rates as one of their most important priorities. In order to achieve this they have appointed a midwife, Evelyn, to provide antenatal and intrapartum care. She is great. Competent and kind, she is proving very successsful at persuading women to attend for antenatal care where several simple interventions can be made to dramatically reduce maternal and child mortality. Specifically, the treatment and prophylaxis of malaria and worms reduces anaemia and the likelihood of death from Post Partum Haemorrhage. Screening and treatment for HIV and syphilis (both probably with around 10% prevalence) reduces congenital transmission, and tetanus vaccination prevents neonatal tetanus. She and Paul are developing protocols for identifying women who are at higher risk of running into problems in pregnancy or labour to target them for more intensive antenatal care and to try to persuade them to attend the centre for delivery. She is seeing about twenty new women a week in a weekly antenatal clinic.
Large family sizes are the norm. This is entirely understandable. Women expect that at least half of their children will die before the age of five and the role of children in the family is to collect water, herd goats and look after younger siblings. Access to family planning is poor. Prolonged and obstructed labours in isolated homes are very common and cause large numbers of stillbirths and maternal deaths.
It has previously been a struggle to encourage women to attend the centre for delivery but Evelyn’s popularity is changing this. As word is spreading amongst the local women, her workload is increasing rapidly. Evelyn is on call 24hrs per day for 25 days then has 5 days off, when labour ward and antenatal clinic are covered by the only other nurse with any obstetric experience. In the week we were there she was up most of the night every night, and looked completely exhausted. There is an urgent need for a second midwife. It would cost approximately £150 per month to cover her salary and other costs. Before we left the UK some of our friends asked us to identify a small project that they could contribute to directly. This could well be a good one. Check out Bwindi’s website at or mail us for more information.
PS I had my first Ugandan snake encounter in the bathroom in Bwindi. Just turned and noticed the snake sitting on a ledge a foot away from where I was brushing my teeth. Made me jump and I had to be rescued by the security guard who whacked it with a very long stick!


Dan said...

Hi Jan and Hi Mark - just checked out your blog site. Thanks for taking the time to post your experiences - they make for very interesting, and somewhat alarming, reading. Keep them coming. Makes life in St. Ives seem rather mundane!

We are all doing fine here. Winter weather begining to set in. I have some new ladies in my life - four pretty white hens. Lets hope they are a good lay! Sarah started with us last week and is enjoying it, I hope. We've all agreed that from April 2007 the Stennack Surgery with be one practice. Lots of change afoot.
Hope you are both well. Big fat Rainbow blessings to you both, my thoughts are with you. Keep safe,
love Dan

ctho5920 said...

Hi Jan and Mark,

Thank you so much for sharing your experience in Uganda with us. I'm heading over to Bwindi next month as a medical student, and I can't tell you how helpful it has been to read about your impressions and experiences.

I feel at least a little more prepared now for the shock I will no doubt receive when I arrive in Uganda.

Keep up the inspiring work!