Saturday, February 10, 2007

Bushenyi Prison screening day

Bushenyi prison, 6km up the road from us is currently home to 406 men and women who have commited a range of offences from underage sex (under 18 in Uganda), to assault, robbery and murder.

If you remember Midnight Express the physical conditions are similar though the staff are friendly and were supportive of the health intervention. The water supply is intermittent. Food is scarce, firewood fuel to cook it is not reliably available and the yellow pyjama’d prisoners are often to be seen at hard labour in the neighbourhood. Inmates for longer than 12 months are clearly malnourished so much so that we mistakenly assumed many more than actually were, to be HIV positive.

We had marshalled a small football crowd of 45 from Ishaka Hospital, 15 trained staff and 30 students. The prisoners were counselled in groups of 50 and offered the health intervention which included testing for syphilis and HIV. 337 of 406 (83%) opted in (as well as 58 staff and their families). All were dewormed. Those who were symptomatic were treated syndromically for sexually transmitted infections (STIs), scabies and malaria. This day came about because both Jan and I had seen large numbers of prisoners in the out patient clinic with florid STIs.

Of the 337 prisoners we saw, more than 300 had obvious scabies, 20 had acute diarrhoea and 10 were hot and fluey with malaria (probably).

105 (26%) had at some time suffered from syphilis (testing positive with syphicheck) and 14.5% were HIV positive (retrocheck confirmed by HIV determine). Two were indeterminate (retrocheck positive, determine negative, statpak negative).

The testkits were donated free of charge by Qualpro Diagnostics from Goa India (huge thanks to them!) The labour was free and the final cost of testing and treating the 395 was on average 75p per person. All those who were HIV positive were given septrin and vitamins and will be followed up with a CD4 count in 2 weeks time.

It was a manic day but every body worked hard in the most wonderfully production line approach to healthcare I’ve been involved with since fluvacc days at home. Even the hour and a half of torrential downpour and the late lunch didn’t seem to dampen spirits. There are some great characters here and we shall miss them when we move on. Sam in particular is a whirlwind of energy, and went backwards and forwards to the hospital and drug shops on urgent restocking expeditions with extraordinary good humour. Molly was fantastic in charge of the pharmacy and Duncan and Vicent did all 790 rapid tests between the two of them.
The bottom picture shows a patient queue of prisoners waiting for their scabies treatment (we were temporarily out of stock!)

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