Extraordinary people

Last week Sarah showed me one of her babies. She had delivered her exactly a year ago in the clinic. Later, I asked Sarah if many of the children she had delivered were brought to see her. She answered yes, but that this one was special. Her mother had been young, alone and ‘disappointed’ to find herself pregnant. So Sarah helps. She visits 3-4 times a week, gives her money when she can, and acts as a second mother to the child. I told her she was amazing. “No! I am responsible for her. What else should I do?” I asked her how many other babies she supports like this and she smiled, shook her head at me and got on with her work.

Yesterday I bought a fridge. I got chatting to the Ugandan Asian businessman who sold it to me. He had fled Uganda as a teenager in the Amin years and settled in Manchester. He returned to Uganda for the first time in 1990. He found a terrible mess. Shocked and desperate to help he decided to help an orphanage. He bought beds, mattresses, sheets, doors, iron sheets for the roof and was happy with his success. When he returned to the orphanage four months later everything had been sold. So he decided he’d have to start his own orphanage, and he did. He fund raised, found some land and built it. The model he describes sounds like a good one. There is a ‘mother’ to every 8 children. She sleeps with them, feeds and dresses them and now takes them to school (also built by him). He gets legal guardianship of the children through the court otherwise when they reach 5 or so and can work someone turns up to claim them. He told me of one eight month old baby brought to him at 1am by two policemen who had heard her crying and had found her in a skip. She’s now a thriving seven year old. He called her Stella.

Mabira Forest and popular democracy

Mabira is a 21,000 hectare tropical forest reserve an hour outside Kampala on the way to Jinja.

In one of his frequent and increasingly out of touch acts of autocracy President Museveni has decided it would be good for the economy to give (yes give) a third of the forest to the Mehta family’s sugar corporation. The trees will be felled at a profit to the corporation of an estimated $500m and then sugar cane will be planted for sugar production.

The issue is a good barometer of the political times in Uganda. The opposition is disorganised and silent. Some of the press is encouragingly vocal in its opposition. Most impressively there is a shared discomfiture about the whole thing. Sms text and web based campaigns of opposition are attracting attention. There is a widely held conviction that Museveni is wrong, has completely lost his populist touch (and is thus time expired) and is profiting personally from the deal (at the very least in terms of campaign fund contributions).

Unfortunately last weeks demonstration against the give away degenerated into violence with some anti – Indian attacks (and some very racist sentiments harking back to Amin’s expulsion of the Asian community) and 3 deaths. There is a perennial fear that Museveni will use demonstrations of political opposition to sanction military and police violence against any form of opposition……

Simplicity

There are many dramatic contrasts between life here and life in England.
As a spoilt rich kid from the affluent North, I find the simplicity and lack of choice here refreshing. Abundant, seasonal, locally grown, organic fruit and vegetables are available from every street corner stall. No processed food (well, there’s tinned tuna…); One brand of margarine (blue band); three cleaning options (vim, omo and bleach). The ubiquitous solid, single geared bicycle, too heavy to ride uphill but very sturdy and with parts and someone who can fix it also on every street corner. Nothing is ever terminally broken. Our ten year old (utterly wonderful) Rav 4 is a Japanese import – presumably shipped here because no one there wants a ten year old car – and is regarded here as ‘new’. A dreadfully rickety chest of drawers at work, not nice when it was new I’m sure, and now with two and a half functioning drawers and a significant amount of termite damage, looked to me to be destined for firewood. Grace, the midwife beamed at me, delighted and disbelieving that she could actually have it for her delivery room. “I can keep all my things in it. Thank you. Are you sure?”

Mark at Reachout

Mbuya Reachout is an exciting and innovative community HIV programme providing medical and social support to 2400 HIV positive clients and their families in a suburb of Kampala. Reachout also runs a training programme for health workers working in the field of HIV.

Reachout’s work is rooted in the community and in particular in the community of people living with HIV / AIDS. The programme models principles of participation and the importance of providing social and psychological support as well as high quality health care. Continuing medical education, case discussions and positive attention to team working with the support of community volunteers are priorities.

The organisation has grown rapidly since start up in 2000 and now employs 230, many of whom are HIV positive. There is weakness in middle management and there is a lack of robustness in its accounting, procurement and stock keeping systems. Dr Stella is instituting a process of organisational review and restructuring over the coming months.

My work plan over the remaining few months will include:

1. Providing medical support to the outpatient clinic and liaising with Hope Ward, IHK which provides us with inpatient facilities.
2. Teaching the trainees on the HIV care programme.
3. Conducting a survey of Reachout clients. This will yield information about family and household structure, the spread of access to Reachout’s social care programme, the prevalence of use of mosquito nets and establish any history of recent household contact with TB.
4. Working with the pharmacy and stores to develop robust record keeping and ordering systems. to avoid out stocking and reduce vulnerability to theft.
5. Assisting Reachout in improving its tuberculosis diagnostic and treatment capabilities. Half our clients will have TB at some point. Half of those who die will die from TB. In particular we should; improve clinicians’ adherence to treatment algorithms, improve X-ray interpreting skills, increase the yield from microscopy, explore the use of sputum culture, consider isoniazid prophylaxis, determine the prevalence of MDR TB.
6. Assisting Reachout in improving its customer care. Attitudes to customers in Uganda as a whole are negative. Patients are expected to wait for many hours and to make unnecessary repeat visits because of system inefficiencies.

mark.russell@ciospct.cornwall.nhs.uk

Jan at Hope

I’m four weeks into my time at Hope Clinic. I’m very aware of not having written about it, but am struggling to know quite what to say. It’s ‘somehow OK’.

Hope is a not-for-profit primary care clinic in a poor suburb of Kampala. Health care mapping here is hopeless and as a result there’s no government provision at all in this valley. Primary care in Uganda is different from the UK. The clinic has an outpatient area (2 rooms), laboratory, dispensary, 10 beds for inpatients and two labour rooms. There are user fees, but they nowhere near cover the cost of running the clinic.

A UK accountant who has lived here for a decade set up the clinic a few years ago, and it moved to new premises last year. The clinic has grown faster than it has been able to cope with and they asked VSO for some medical and management input.

Enter the queen of the protocol.

It’s work I can do, and I know they need. It’s a worthy cause. It’s a perfect VSO placement and it’s exactly what ‘development’ is about.

My ambivalence, I’ve decided, is pure selfishness. I loved the buzz of Ishaka, the challenge I faced every day, not having a clue what I was doing most of the time. I was learning at a phenomenal rate. It too was exactly what development should be about.

I know which I’ll choose next time…