This is my 10th year of regular visits to Uganda. It has been an exciting journey of personal learning and observing continuous change and development.
To take an obvious example, many roads here have been immeasurably improved in the last 10 years
As for healthcare, progress is often a bit slower and rather less obvious. However, there has been very real change, not least at Kamuli where my Ugandan medical career began. It is fair to say that the infrastructure we have helped to create there means it is barely recognisable compared to my first visit.
I’m delighted to report that the main focus of this visit is a major milestone in the transformation of a second hospital. Freda Carr, Ngora was once a leading hospital in rural Uganda but has since suffered a sad decline. It is in a much worse state than Kamuli was when I first visited. But all that is about to change. Once again, this is due to the combination of working with colleagues on the ground in Uganda, generous donations from those at home and support from Rotary. August 3rd 2018 sees the formal launch of a project to refurbish the maternity ward and the operating theatre and erect a water tower.
Interestingly FCNH was founded in 1922 by a Briton living in Nairobi in memory of the 12 yr old daughter he had lost. Here is a picture of the early beginnings – the first doctor doing an early outreach clinic.
Once again Bristol University has sent 4th year medical students to Kitovu and Villa Maria hospitals which provides the students with a unique experience and the hospitals with a welcome financial boost. There are plans to extend the visits to a third hospital next year.
Over the past seven years I have worked closely with a Ugandan, Dr Rogers Kabuye, who has been my cultural and technical guide and mentor. Without the benefit of his intimate knowledge of local healthcare, we would have achieved very little. Rotary Doctor Bank have recognised his contribution to our work by awarding him a Paul Harris Fellowship. This is Rotary’s way of recognising outstanding service. It was presented recently at a meeting of the Rotary Club of Kampala Central.
As you are still reading this, thank you for coming with me on this journey. Your support and encouragement have kept me going and there is still so much more to do.
Jim McWhirter, July 2018
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Our next major project is at Freda Carr Ngora Hospital for which a Rotary Global Grant application has been submitted recently.
A building refurbishment programme will upgrade the maternity ward and operating theatre and construct a water tower.
A Rotary Vocational Training Team (VTT) of UK doctors, midwives and paediatricians will visit every 6 months over the next 3 years to teach essential lifesaving skills to healthcare staff and students at the Nurse Training School. The VTT has just returned from its second planning and assessment visit during which training was given to 213 people.
You can read more about the VTT at https://www.rotary-ribi.org/districts/page.php?PgID=679420&DistrictNo=1090
This was my fourth visit to Uganda and my second with the Rotary Doctors Bank previously having spent time at Villa Maria Hospital. Prior to my visit to Kamuli, I was dismayed to receive the news that following, an inspection the X-ray Department had been closed by the Ugandan Atomic Energy Council (AEC). The Medical Superintendent, Dr Andrew Muleledhu, e-mailed with a list of requirements, mainly radiation protection issues, that needed to be met before the Department could be reopened. This then gave me a good focus for my trip and enabled me to do some preplanning and research before I left home.
They have been unable to employ a qualified radiographer at Kamuli due to lack of funds and the inability to attract staff to such a rural location. They therefore employ Joseph as a layperson to take and develop the X-rays. He has received minimal training in radiography positioning but no training in the principles of radiation protection. I was also told that theirs is the only functioning X-ray department in the district and if it is out of action patients have to go to Jinja which involves at least a 3 hour round trip. This is obviously not an option in an emergency.
Joseph positioning a patient
When I arrived at the hospital I was made to feel welcome and was impressed by the helpfulness of the staff. I was pleased that they had built an X-ray screen for staff to stand behind when taking the X-rays. The Department had therefore been reopened by the AEC but was due for a re-inspection in a month following completion of the other recommendations. One of these involved establishing a new Darkroom, which was at present very inconveniently in another building amidst a lot of rubbish. With help from the carpenter, electrician and a team of strong men we cleared and cleaned a room within the Department and set up a new Darkroom.
Another major concern, which came to light whilst I was there, was the inability to produce a diagnostic X-ray of a spine, abdomen or pelvis. This was due to a piece of equipment called a grid being missing from the X-ray table. Luckily I managed to locate one on an old piece of equipment in a storage cupboard and with help from the electrician extracted it and cut it to size. We then managed, with the help of some sticky tape, to put it into the X-ray table. This now means that patients do not have to have a trip to Jinja to obtain a diagnostic X-ray.
I brought with me from the UK new lead aprons, thyroid and gonad protection as well as X-ray cassettes, which require a lower dose of X-rays to produce an image. I also spent time establishing new exposure factors.
Joseph modelling a new lead apron.
I would have liked to have spent longer at the hospital and hope to revisit as I feel that Joseph although excellent at chest X-rays would benefit from some teaching on radiographic technique for other parts of the body. I also feel that it would be of benefit to the nursing staff to receive some basic training on the safe use of radiation, as there seemed to be a lot of confusion on this.
My other area of concern is the developing of the X-ray films, which are “wet developed” at present. This involves manually immersing the films in the chemicals. This is not only a hazard to Joseph as the chemicals contain carcinogenic substances but also the quality of the X-ray suffers due to inconsistencies in the process and the fact they are then hung on the railings to dry! I am therefore hoping to find a small automatic film processor for Kamuli; similar to the one I took to Villa Maria.
My 17year daughter accompanied me, on my visit, and we would like to thank everyone at Kamuli for their friendliness and making us feel so welcome. My daughter spent time in a local primary school and was also invited to spend time on the wards shadowing a doctor and spending time with the student nurses. She is now considering a medical career!
On this visit Bristol University asked me to accompany 20 of their 4th year medical students and four of their tutors on their visit to Kitovu and Villa Maria hospitals. This is the fifth year in which Bristol has sent students for a three-week study period in Uganda. The hospitals receive financial support in return for hosting the students who receive a fascinating insight into a completely different medical and social environment.
Most of them gave a blood donation, many for the first time.
In addition to financial support, Bristol sent a large amount of useful medical equipment
While at Kitovu I was able to review our projects there. The staff loan scheme goes from strength to strength and is a great help for staff recruitment and retention, which are always major problems. We have given loans which this scheme uses as working capital and they have always been promptly repaid.
Another loan, now repaid, was used to complete the x-ray department which will shortly be fully functional, including a CT scanner which is a rarity in a mission hospital.
They are in the process of building a new ward with single rooms. Our loan has enabled completion of the ground floor and patients will be using it in the very near future. A second floor will be built in due course as funds become available.
Our next big project is the refurbishment of the maternity ward and operating theatre at Freda Carr Hospital, Ngora, in north eastern Uganda which is a poor area.
Planning for this is progressing well in cooperation with the Rotary Club of Kampala Central and we expect to submit an application for a Rotary Global Grant this autumn. The vocational training team which visited from Rotary District 1090 this spring was enthusiastically received. We are optimistic that we can initiate a major transformation in this rundown hospital along the lines of the work that succeeded so well at Kamuli in the past. The buildings to be refurbished are shown below:
Maternity ward Operating theatre:
This project will greatly improve the lives of mothers, babies and surgical patients in this area.
In April 2017 Rotary District 1090 sent a team of a doctor and two midwives to Freda Carr Hospital, Ngora, to train hospital staff and students at the School of Nursing and Midwifery in lifesaving skills for mothers and babies. This is the first 1090 VTT visit to Ngora which is set to receive ongoing visits as part of a Rotary global grant funded project to improve facilities and services at the hospital.
Those of you who have been reading these reports since 2009 will have noticed that they have changed significantly over time. Early reports were full of the emotional impact of seeing human suffering at first hand and the culture shock of coping with the very limited resources available to help.
Inevitably one becomes accustomed to seeing these things and latterly reports have concentrated on our efforts to make longterm improvements. Although improving the efficiency of hospitals is critical to saving the lives of mothers and babies, it doesn’t make such good reading as details of practical work on the hospital wards.
On this, my 15th visit, I have been deeply disturbed once more.
Uganda is a green and pleasant land thanks to two rainy seasons each year following the spring and autumn equinoxes.
Last year the September rains failed with severe consequences for rural subsistence farmers, the community that most of our patients come from and the bulk of the Ugandan population. There are food shortages, increased prices and many are down to one meal a day in the rural areas. In field after field the maize crop has died as shown in the pictures:
Hopefully the rains will come again this spring and set them on the road to recovery but if they don’t, it will be very serious. It is easy to overlook how vulnerable these poor countries south of the Sahara are to changes in climate and how we cannot take well established historical weather patterns for granted.
On the project front we are seeking to repeat the successful programme we implemented at Kamuli in a much poorer setting in Eastern Uganda. We hope to refurbish the maternity ward at Freda Carr Ngora Hospital (pictured above) and send a Vocational Training Team to boost education at the nurse training school, all with the help of a global grant from Rotary. We are receiving strong support from the Rotary Club of Kampala Central and the Uganda Protestant Medical Bureau.
One of the great joys of coming to Uganda is the opportunity to meet the most incredible people. I have previously mentioned the Kamuli anaesthetic officer who works literally 24 hours a day, 365 days a year and Dr Maura Lynch of Kitovu, a nun and surgeon who celebrates 50 years in Africa this year. Both of these are still working in their 70’s. On this trip I met an 80 yr old ophthalmologist who has been 52 yrs in Africa, still works full time and spends two weeks each month travelling all over Uganda taking his surgical skills to remote communities. His name is Keith Waddell of Ruharo hospital and he is photographed with his team on an outreach journey. Between them, these three remarkable people have 151 years of service. I feel I live an incredibly lazy and self indulgent existence!
Every visit to Uganda holds surprises, some pleasant, others less so.
The road network has improved dramatically over the past eight years but this is a mixed blessing. On the upside, travel is quicker and more comfortable with less dust and fewer bumps. On the downside, local drivers have a lot to learn about the hazards of high speed travel. When we found ourselves in a major traffic jam following an accident, we took to the side roads (!) to try and get by but unfortunately met others doing the same from the opposite direction! Fortunately my travels were otherwise uneventful apart from paying more for petrol post Brexit.
My first job was to welcome 20 Bristol University medical students and see them on their way to Kitovu and Villa Maria. These hospitals have hosted Bristol students for four years now, providing 50 in total with exceptional learning and unforgettable medial experiences. Next year we hope to extend this programme to Kamuli as well.
One of the main objectives of this visit was to complete the process of setting up the Medicaudit Foundation in Uganda as a fully fledged non-profit organisation. It will partner with Medicaudit Ltd in Uganda and Rotary Doctor Bank in UK and oversee the work of supporting rural hospitals which has been developing so successfully over the past four years. We now support 24 hospitals, 7 clinics and other sites including pharmacies and even a hospital farm! Your generosity has secured the future of this work which goes from strength to strength.
The inaugural meeting was held by the founding members, somewhat informally, over dinner in a cafe in Kampala:
A critical element of the Foundation’s work is computer system support and as our network spreads further afield, we have developed ways of providing remote support over the internet to cut down on the need for staff to waste a lot of time travelling. It never ceases to amaze me how we are able to productively and cost effectively use up to the minute technical solutions in a low tech society. But it really does work and our hospitals are constantly improving the care they are able to give patients.
Medicaudit is sponsoring one of its employees, Nicholus Seguya, to undertake further training by doing an MSc in Public Health Informatics at Makerere University, Kampala.
An exciting new project is helping the Rotary Club of Thanet, UK, with their project to improve water supply and sanitation at Soroti Regional Referral Hospital. I visited this incredibly hardworking hospital again and look forward to developments in the coming year
While in the east I visited the Medicaudit project at Ngora. This hospital was a leader in many spheres a long time ago but after a period of decline it is heartwarming to see it recovering. There is huge scope for useful projects here and Medicaudit is closely involved.
Jim McWhirter, July 2016
I’m not superstitious but I did have my laptop stolen on my 13th trip to Uganda, just concluded. The interesting aspect of the story is that when thieves broke into my colleague, Rogers’, home when we were upcountry visiting hospitals, they stole an ipad I had passed on to him a couple of years ago. Although we were a six hour drive away, he was able to track the movement of the ipad on the internet which enabled the police to make an arrest and recover it.
Africa is a fascinating mix of old and new. The heartwarming part of the story is the way the family rallied round. Brothers came round to stay with his wife and children, assisted with clearing up the mess and running around informing the police and providing the information to catch the thieves. This enabled Rogers and me to continue our work for another 24 hours, keeping in touch by phone.
The extra time the family support gave us allowed me to attend meetings in Soroti to help move a water project forward for the Regional Referral Hospital. It serves a very large, poor rural area. At any one time there are about 3,500 people on the site and they have to do everything with a water supply which is usually only available for 4 hours each day. Unimaginable! The picture shows part of the 9 am daily outpatient queue and there were a further 100 patients waiting for the surgeon.
While in the area we had visited two of the hospitals using our Medicaudit management system.
I was at Kumi 18 months ago helping to install Medicaudit. They have worked very hard and have doubled hospital income without increasing patient fees. Similar results are achieved at many of our hospitals allowing them to increase expenditure on staff and equipment and so improve patient care with the result of saving of more lives.
Ngora has only recently started with Medicaudit but is making great progress from a very low base.
Nearby there are some fascinating cave paintings which are over 3,500 years old.
We have made great progress over the past two years and are now supporting 20 mission hospitals, 2 private hospitals, 7 mission health clinics, 3 private health clinics, a mission wholesale pharmacy and a mission hospital farm! We have one hospital in Kenya and strong interest from Malawi. We are working on a plan for further steady development.
On this trip I visited three more of our hospitals. The highlight was a return to Kamuli where my Ugandan career began. The hospital’s only anaesthetist, Sebastian, works day and night, 365 days a year. He began work in 1968 and started giving anaesthetics in 1972 and is still the single most important person in the hospital at the age of 70. It is impossible to even guess the number of lives he has saved. It is seeing dedication like this that makes it impossible to to walk away from helping.
It was therefore a special pleasure and privilege for me to present him with a Rotary award for outstanding service (a Paul Harris Fellowship) on behalf of Rotary Doctor Bank GB&I. He is pictured with his wife.
As always, your continued support is what keeps it all going and I hope you can share with me a sense of pride in what we have achieved and excitement about what is yet to come.
Jim McWhirter, January 2016
This was my twelfth visit since beginning work here for Rotary Doctor Bank in 2009.
It was the first opportunity to see for myself the completed major hospital refurbishment project at Kamuli. Everyone who has donated should feel a great sense of pride at having contributed to an effort which is transforming the physical fabric of this hospital which serves one of the poorer areas of rural Uganda.
On my first there were only two buildings less than 10 years old and most were over 50 years old. Now the new buildings outnumber the old ones and the whole place has a completely different feel.
A Rotary Global Grant funded the refurbishment and extension of the maternity ward and the refurbishment and major extension of a derelict building wh
ich had p
reviously been the operating theatre and is now used as a ward for VVF surgery. This work is carried out by the Uganda Childbirth Injuries Fund which makes an almost immeasurable difference by improving the quality of life for women injured in childbirth. It is hoped that the improved facilities will make possible a significant increase in this work.
The work at Kamuli is being carried forward by Dr Philip Unwin of Henley and his niece Dr Alice Unwin. Alice first went there five years ago as a medical stude
nt on an elective. They have made a massive contribution by building a guesthouse for visiting volunteers and accommodation for the staff.
All these initiatives and improvements have led to a reduction in staff turnover which is one of the major problems in these rural hospitals.
Of course it is the quality of care within the buildings this is actually the most important thing. I am delighted to say that Rotary in the Thames Valley is addressing this. Part of the Global Grant project was a team of midwives and doctors who visited twice to teach essential life-saving skills. Following on from this the Rotary District (1090) has undertaken to fund twice yearly visits to reinforce and continue this work for mothers and babies. This is also supported by Rotary Doctor Bank and the Unwins’ charity “Kamuli Friends”.
This is the third year that Bristol University has sent fourth year medical students to Uganda. This year nine students went to Kitovu and Villa Maria hospitals. They were very happy when they heard that they had passed the exams they had sat just before leaving.
On a more serious note, they all had a profound and fascinating experience which will contribute significantly to their personal and professional development.
I was able to review the work of Medicaudit which is making good progress helping rural mission hospitals improve their efficiency and the quality of care they give patients. We are now working with 18 hospitals and 7 health centres, most of whom are seeing significant improvements in their income as a result. The project is on target to become self-sustaining by 2018.
Rotary Doctor Bank has been very active this year sending out many volunteers. I visited Buluba, the hospital which will have received four RDB volunteer doctors this year, providing virtually continuous cover for the whole year. For the first time RDB sent out a radiographer volunteer who had a very successful time at Villa Maria installing donated equipment, instructing local staff and dramatically improving the quality of x-ray films.
As always, I owe a huge debt of gratitude to all of you for giving such great support to this project over the last six years.
In this report I want let you know what I am doing and how Rotary Doctor Bank is spending your donations in Uganda.
The objective – to save lives, especially those of mothers, their babies and children – remains the same. But over the five years I have been coming here, the method has changed significantly.
Being a doctor, my first inclination was to work on the maternity ward which I did at Kamuli for six months spread over my first three years. This undoubtedly saved some lives and was personally rewarding. However, between visits nothing changed and staying in Uganda long term was not an option for me. So I was wondering where to go next….
At this point, by happy coincidence, I met a Ugandan doctor who was addressing many of the problems that troubled me in my work here. Lack of essential supplies was a constant frustration, but trying to discover how much of this was lack of resources and how much was inefficiency, was beyond me. The lack of resources was unquestionably very real but so was the inefficiency. And if you have few resources it is even more important that you avoid waste and manage them efficiently.
Fortunately my new found Ugandan doctor friend, Rogers, had the answer. He previously had been in charge of a rural mission hospital and had written his own computer programme to help him in his work.
Further development of the programme and trials in a few hospitals had led to a working management tool which increased hospital income and efficiency without increasing the fees charged to the poor rural populations these hospitals serve.
Good news spreads fast and I met Rogers just at the time when demand for his system (Medicaudit) was rising but hospitals could ill afford the upfront computer costs to get it started.
And this is where you come in! Funds donated through Rotary Doctor Bank paid the modest £1,500 start up costs for each hospital, after which they required no more funding as they saw their incomes increase.
Only one problem remained. Until this year Medicaudit was a one man band with Rogers providing installation, training and support to a dozen far flung rural hospitals from his base in Kampala. Medicaudit had to expand or grind to a halt.
A five year plan to develop Medicaudit leading to a self sustaining non-profit organisation was drawn up. A generous private donor offered full matching for funds raised by Rotary Doctor Bank for this work. So now they have a staff of four and rapid expansion well ahead of the original plan of six new hospitals a year starting in 2015.
On this trip we visited six hospitals in the first week to review progress and problems. In the second week I went with Rogers and new team member, Nicholus, to observe (and occasionally help) as they installed the system and trained the staff at Kumi hospital in Northern Uganda.
The challenge of establishing working computer stations at reception, cashier, patient billing and accounts departments over a local network with many staff using computers for the very first time, should not be underestimated – and all in three and a half days followed by a seven hour drive back to Kampala.
You would naturally conclude that this could not possibly achieve anything useful but you would be wrong. Experience has proved the method in 15 hospitals so far and there is every reason to believe that the 16th will not be an exception. A follow up visit in a month or so will consolidate progress, continue training and encourage gradual extension of the system. Hospital motivation develops rapidly as they see cash income rise as the computer tracks all transactions and identifies problems to be addressed.
So, by helping to make hospitals more efficient and self sustaining, mothers and their children, as well as other patients, will benefit and more lives will be saved.
As always, thanks to one and all for your support as this project moves forward to a very exciting future!