​Why can’t our health system deliver for the common Ugandan?

Pictured below is a running drip hanging from a suitcase in Accident & Emergency (A & E) ward, Mulago, on one of several busy mornings.

That, and similar kinds of ingenious inventions are what the medical students, interns, nurses, and senior health officers on rotation in A & E have to resort to.
Like former US President Theodore Roosevelt said, “do what you can, with what you have, where you are.” Where we are is, as one famous girl child activist Dr Stella Nyanzi in the media called it, the Boda-boda generation, and what we have is a health system in desperate need of revamping.

With the convenience of a boda-boda comes speed, and every other day the Casualty Department of Mulago Hospital wheels in victims of boda-boda accidents; users, riders, innocent passers-by. But there are only so many inventions a health professional can come up with and at the end of the day, when even basics like gloves become scarce, our hands are tied. 

About $150m, about Shs 400bn annually is spent out of the country on medical bills for senior government officials, MPs, senior Army officers! Yet Mulago Hospital complex altogether receives only about 7bn annually from the Ministry of Health’s share of the national budget. The lack of prioritization for our health system is, and has been, killing it for a very long time. And unfortunately, the average Ugandan solely relies on the cheaper government run health facilities like Mulago National Referral Hospital for health care without the luxury of insurance in private clinics. Recently when Kitgum Woman MP Beatrice Anywar was involved in a road accident, she was promptly airlifted to Case Clinic in Kampala—a privilege the average citizen does not enjoy. If our leaders understand the preference of Case Clinic over Mulago Hospital, it’s a wonder drips hang on old suit cases in hospital corridors. Do we vote badly then? Why does the common man continue to suffer?

Has all hope been lost? There has been a promising though dragged conversation on the Uganda National Health Insurance Bill 2007. The possibility of Ugandans to afford universe health care coverage is exciting! The proposed plan will have the scheme financed by 4 percent monthly contributions from an employee’s earnings, with the employer contributing an additional 4 percent. But meanwhile, Ministry of Finance has already given negative feedback as regards the certificate of financial implication. Mbu ‘where will government get money to cover for indigents?’; When Shs139b in FY 17/18 budget is planned for special meals, drinks! More to this reality is whether our national healthcare centres will be responsive and satisfactory when the working class come knocking. Have doctors and other health personnel been motivated enough! What has been/will be the fate of the informal sector ( tomato sellers, hawkers, boda-boda riders and peasants) who are the bulk!

And finally the fundamental contradiction still lingers; how people in top government positions, even the president of Uganda can’t consume the same exact health care services they plan. This hypocrisy needs to stop!

We can win against cancer

With the numerous Cancer Runs, are we going to run over Cancer? Are we going to have a car wash for every needy Cancer patient in Uganda? These are some of the lingering questions currently in the public domain conversation of Ugandans are the whole nation doesn’t have a single Radiotherapy machine. In the recent past, we had the Rotary Cancer Run 2016, where 0ver 36000 sweated it out as they raised about 400m for a cancer machine for Nsambya Hospital. This month being the month to accentuate the fight against cancer, a lot has been organized; digital campaigns #SaveCarol , #EachOneReachOne, #Bunker4Mulago other runs, poetry and more. It demonstrates  the will of ordinary citizens in the fight against this scourge by drawing courage and energy from their  personal experiences.

To be diagnosed with cancer in Uganda can equate to a death sentence as there’s also reported fake anti-cancer drugs on the market. Can’t some of these goon importers be charged with murder! I will choose to save this particular conversation for another time.

Let’s talk about the cancer state of my nation Uganda,  The incidence rates are higher for prostate, breast and cervical cancers. In 2015 according to the Kampala Cancer Registry, we registered 5.7 per cent new cases of prostate cancer. For breast and cervical cancer, it is 3.7 per cent and 1.5 per cent, respectively. In population of 100k, 3,700 people are newly registered breast cancer patients. Alone, breast cancer victims average 22000 per year. In about 20 years, breast cancer will be the commonest cancer among women. What a sad future to possibly unfold on top of a helpless present!! There is an ongoing conversation on the economic implications of this as women affected are the most professionally and family active.

The ignored but serious variant is Prostate cancer. An estimated one in six white men and one in five African men will be diagnosed with prostate cancer in their lifetime with the likelihood increasing with age. The presenting symptoms commonly include urinary retention and back pain. For the menimists, this should be our real fight.

To share my personal insights, the fight against cancer is sure on and steady. But we need to think sustainably if we are not to burn out. In the light of evolving dietary modifications from our Luwombo to Kentucky Plastic Chicken, from playing football to FIFA and increasing environmental stressors, the fight upon us is a huge one. I believe with can win through structural and lifestyle modifications.

Structural; here I call on government and related NGOs to take the fight to lowest levels. We need to have routine cervical cancer screening at all local health centers(HC) as far  HC IIIs and consistently. The focus should be on preventive. As many as 80% of all cancers are CURABLE with early screening and diagnosis.

With lifestyle modification, we need to unlearn most of the predisposing daily habits. One needs to live cautiously and actively; eat a fruit daily , vegetables, stop smoking, moderate on alcohol intake (not more than 2 units daily),  practice safe & protected sex, and have at least 150mins of moderate physical exercise per week.

Cancer should be fought in our daily routine. We as, Ugandans, Africans and the globe must to own up to our own health. Yes together, we can win against cancer.

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Author (far left) with fellow Rotaract Club of Mulago members during Cancer Run 2016. #RotarayCR16

Experiences from Kisiizi

On my journey to Kisiizi Hospital, I didn’t know much about where I was going to explore for next two months except that which I had heard from my mother-that I took my first breath there. I was yet to gain my own experience more than twenty years later.

Kisiizi Hospital gets its name from the Majestic falls, Kisiizi falls which stand about 100 metres tall, few yards behind the hospital itself. You can always feel the aura of cold breeze roaming across the hospital compound especially in the morning! Historically It a monument in history of Kigezi where young girls who took an early pregnancy before marriage were thrown over by their own brothers as a punishment.

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Author (far right) and fellow medic collegues at Kisiizi falls.

Kisiizi Hospital, a private not-for-profit hospital institution is found in Rukungiri district, south-western Uganda, approximately 42kms by road from district headquarters. It is a Church of Uganda, community hospital founded by Dr John Sharp a missionary doctor in 1958. The bed capacity of Kisiizi hospital is 250 plus 10 incubators in the Special Care Unit.  The hospital is a fees-paying hospital though no one is turned away due to inability to pay. The fees collected from the patients cover 40% expenses with supplementary coming from other hospital ventures. It receives 4% support of expenses from Government of Uganda.  The hospital also receives contributions from donors within Uganda and overseas.

One of supportive institutions is Kisiizi Hospital School of Nursing training about 200 nurses and midwives each year, who use the hospital facilities for their practice. There is also the Kisiizi Hospital Primary School for educating the school going children of the hospital staff and the catchment community. The illuminating Kisiizi Electricity has a 300 kW hydroelectric project which supplies the hospital and the town of Kisiizi. All these projects give Kisiizi Hospital a strong stand at its motto “Life in its fullness.” Kisiizi town center thrives on its own like a self-contained haven.

Providing quality and affordable care to a rural population has never been easy feat to pull off; in most parts of the country, it is an illusion. What stood out for me is how people in a rural setting were able to access this quality of care! It’s key to note that all the relevant specialists (surgeon, obstetrician, physician and pediatrician) are available; 14 days a week.

The Hospital runs an amazing Kisiizi Hospital Insurance Scheme covering members in 4 local districts of Rukungiri, Kabale, Ntungamo and Kanungu with over 360000 registered beneficiaries. Each member subscribes with Ug Shs 14000 per year (<$4) and receive a range of essential medicines free, cover for all emergency health problems and acute illness and up to 25% subsidized fees on major operations. This is particularly relevant in the context according to the global health expenditure report 2014 where 41.3% of Ugandans finance their health bills with out-of-the-pocket payments with no functioning national health insurance plan.

According to World Health Organisation’s Africa Health Transformation Program 2015-2020 with a vision of Universal Health Coverage (UHC), a health system attains UHC when all people receive quality and equitable health services (promotion, prevention, treatment, rehabilitative and palliative) without financial and other barriers. So when the Director World Health Organization Dr Chan talks about UHC, I don’t see how less Kisiizi has been a pioneer in this, providing financial risk protection to its patients. The challenge to universal health coverage is not just geographical, but also in the availability of access at all times of day and night.

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Kisiizi Health Insurance network

 

The insurance scheme is an example of the provision of “quality health care to poor people in support of goals such as universal health coverage and patient safety.  A big ingredient to this being possible has been creating trust in the system and Kisiizi being a faith based health facility has had that to its advantage. If this model can be translated to other regions, or at national scale, as a Nation we can then begin to talk about real transformative health care delivery.

The hospital has taken the edge in the use of ICT in hospital care, with introduction of a streamline system stream@line. The Stre@mline, an IT system designed in Kisiizi, captures all prospective data on patient’s vitals, diagnosis and allergies will help to address the concerns about poor quality, patchy data and will instead help to provide “more robust evidence for reforms in patient care. It ensures patient safety and encourages good record of patient well-being over time. The care offered at Kisiizi is one to be rivaled for the quality and reach to the people who are in most need for it. Being enlisted by WHO as a model hospital in Uganda, two in Africa for best safe surgical practices is one that has attracted other institutions to pick a leaf.

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Inside on of the operating theaters in Kisiizi Credit; G, Okumu

This is slowly opening a new chapter in healthcare of medical tourism here in Uganda, and Africa as a whole. Satellite hospitals have flocked to learn from this budding community.  How such a small place can come to give life to people in 60km radius area is something to reckon with! With the medical cases it attracts, it makes it one of good places for an undergraduate student to get hands on. Maybe it is high time we also built on these unique local advantages at each health centre to attract and also maintain health practitioners.

I also took the chance of the typical Kigezi hilly countryside to get in touch with majesty of the intertwining hills. Climbing some of these exercises your heart and lungs, leaving you challenged and wishing for less. I cant forget to salute my fellow colleagues and special friends I met in the medical interns in Kisiizi; they kept it warm.  I surely experienced more than what meets the eye in Kisiizi; Hasta la vista.

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Trekking the mountainous countryside.

 

 

 

 

 

 

 

 

 

Student Social Action; a case of a health initiative.

Social action is about getting involved and doing something to help others. It’s not about how much money you give; it’s learns towards giving your time. More like giving back to community. Some students are moved to take action against social justice. The most serious start out by critically examining some root causes of social injustice and collaboratively develop interventions. Then these fellows develop and implement a social action project that addresses a social justice issue in the community.

Most times these students find inspiration in common places-in class, through conversation with peers, in the media and commit themselves to turn their inspiration into action.

Alas you might have come across a characterization of students as apathetic, lazy, and uncaring-personal apathy and structural apathy.

Personal apathy is when individuals do not care and are unwilling to be involved. Structural apathy occurs because individuals are unaware of meaningful opportunities and are not asked to serve. I can tell that groups of students have come out, developed the structures and opportunities that would entice and engage more students to become involved. They have committed to imagining a better world and actively bringing about positive change within their campuses and communities.

There is no question that changing the world can be a daunting task. The thing is, college youth are often an untapped source for creative change-making ideas. When young innovators have the support they need at every step of the process you may be surprised with what they can accomplish; on their campuses, in their cities, and beyond.

Talk of beyond, this was highlighted by when Oxford students meet with Makerere University students in the Katanga Hand washing project under United Partnerships-a student led movement.

To draw a moment from my recent past; On my daily trek through Katanga Slum from main campus to Mulago, my eyes were always meet with poor sanitation and jumping trenches-the norm sight of a Mulago Medical student. Most of the kids from Katanga presented with diarrheal diseases. This was always augmented by the recurrent cholera outbreaks in the slum that we can call our own-Katanga.

WHO research shows that 43% of these can be reduced by proper hand-washing. It’s from this evidence based fact that we set out to fundraise and install five tippy taps on major communal toilets in Katanga.

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Demostrating the use of tippy tap at one of the five public toilets in Katanga Slum.

The whole project took about $100 to impact over a 100000 people slum population.

The assessment survey done by revealed very positive results among slum dwellers. It is such simple but relevant interventions, one example product of student involvement, which we can use impact the world around us with.

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Students from OxMak and  Youth Association of Community and Occupational Health (@YACOH-uganda) with dwellers.

And definite steps need to take to inspire, catalyze and sustain most of student-driven change by first believing, committing , connecting, implementing , repeating in case of short term failure. Most have come out of student initiative but higher institutions need to enhance civic engagement by providing critical social service and learning opportunities as part of university stay. They must take their level of involvement to the next step promote and support college student involvement in thoughtful community service and civic engagement. I therefore call on fellow students, and those of life to challenge themselves and better the world around them.

 

The writer is a former GRC School of Medicine, Makerere University and Founder President of Youth Association of Community and Occupational Health (@YACOH-Uganda).

 

Afrikan Youth Centrered Solutions

A group of University students from Kigezi Sub region proposed the formation of an association for University & College School students worldwide whose roots trace back to this region. The fact that this sub region has produced some of the best students in the country who have undertaken many programs ranging from Human Medicine to Law has provided created a need for a platform to synchronize the potential from these students promote the success of the region. The core values that we hold close to heart include; networking, education and culture. As the adage goes, Your network is your net worth networking important in order to foster social support and mutual helping; education to share ideas from the various fields of study by the students; and culture to stimulate self-expression, happiness and health. From the last core value, we need to identify us selves more as Africans to derive our inspiration from our rich heritage. The main scope of activities has been ; Inspirational talks, Carrier Guidance ,Community Service; and Mentor-ship Programs.

In the same angle, Uganda to date has a large population of Youth who need to be nurtured to fill the gap effectively in the next generation of Ugandans. While many are fighting to grasp on power, the real plight and future of current Ugandans has actually been left to us the ‘young’ Ugandans to take on head-on.

Right at the heart of our working is design thinking, a formal method for practical, creative resolution of issues with intent of an improved future result. In the new century, we are faced with a new wave of challenges most that stem from our own existence. It would be befitting only to get back to the drawing board and rethink our strategy. Our approach to things may be decried by many as crazy at times, but we can help it being in this era, at the forefront of our own generation, and that of our grand kids to come. “If you do what you’ve long done, you will get what you have always gotten.” Tony Robbins. This couldn’t have been highlighted more than at our launch “Connecting minds, building the future” of Banyakigezi University Students Community at Makerere University. We had a live brainstorming session where our members in the Diaspora tuned in the conversion via videoconferencing. We launched a girl child education program alongside a series of inspirational and medical camps which we recently put to action. This clearly demonstrated our zeal for a common cause yet we were separated by oceans further highlighting the point of harnessing today’s technology to accelerate projects. Even as students, we can be game changers of today, if we dare dream and work with a passion for the future we desire.

Prior to our launch, we participated in the Walk for Mother Initiative, which was meant to raise funds for maternal health in Kigezi Sub region. We marched through streets of Kampala City with banners and placards with Maternal Health awareness messages. The funds generated were utilized in buying a generator to support child deliveries at local health center Rugeyo HCIII in Kanungu District. We hope to inspire more students to be proactive in the change they desire. The more got more involved in community as early as student level, the bigger an elite population we will have that’s more attached /connected with development of their respective communities. Only if the so called ‘elite’ population-studied and rich are involved in grass root development can we have transformational change.

We build the future. For God and My country

Prosper Ahimbisibwe

GRC School of Medicine Makerere University

Banyakigezi University Students Community.