Refurbishment of the maternity ward, operating theatre and water tower at Freda Carr Hospital, Ngora, has been completed. The project was handed over to the hospital on 31st August 2019. The work has been led by the Rotary Clubs of Reading Matins in the UK and Kampala Central in Uganda. The $216,500 cost was supported by a Global Grant from the Rotary Foundation with contributions from 9 Rotary Clubs, 5 Rotary Districts, Rotary Doctor Bank GB&I and WASRAG.
The main purpose of this visit to Uganda has been to check on progress of the building work going on at the Freda Carr Hospital at Ngora funded by a Rotary Global Grant.
We are refurbishing the maternity ward and the operating theatre and constructing a walkway between them so that mothers can be wheeled on a trolley in comfort before and after caesarean section. In addition we are erecting a new water supply tank to replace the present one, as its foundations are giving way.
The pictures below illustrate the buildings’ condition before we started work last August and the current state now:
Work is expected to finish in the next couple of months. The project also includes equipping the wards internally and sending regular vocational training teams to improve the quality of care delivered by staff.
Our main ongoing project over the past seven years has been to help rural mission hospitals become self-reliant through improving their management. This support has been extended to 24 hospitals across Uganda. Previously we have focused mainly on financial management. The current phase of development is to enhance the systems to cope with recording all the patients details and so generate good quality medical data which will not only help the hospitals but act as a valuable resource for health care planning and research.
To this end, we made contact with the UK based Medical Research Council which has an office in Entebbe. The Chief Operating Officer, Susanne Rupp, kindly visited Naggalama hospital to see our work in operation. MRC has long experience of research in Uganda and will help us to develop our system more effectively.
David Robertshaw joined me for the first part of my visit. He has wide experience of computer management and may be able to help us with our future development.
We also met Prof J Meirion Thomas, a senior semi-retired surgeon who worked in Uganda in 1979 and is considering coming back again to help.
We are very grateful for the help so many give us.
It was very good to hear that the staff loan scheme we have been supporting at Kitovu hospital over the past four years has produced many benefits for their staff. Some practical examples are detailed below.
Hospital staff achievements using loans from the scheme
Start-up of personal income generating projects: Staff have invested in construction of rentals, crop farming like planting coffee, maize, banana plantation, poultry, piggery, cattle, general merchandise, mobile money business etc.
Mukasa Harriet a nurse with ART programme of the hospital got a loan from the scheme and bought a chunk of land from which she currently grows crops for home consumption as well as selling. Her dream is to use one part of her land to construct her home and the other part for crop farming and poultry:
Hospital Records Assistant-(Mukaisenje Jovanice) managed to put up a retail shop as her income generating project using the loan she got from the scheme. In her kiosk, she hired an attendant who works tirelessly to prepare breakfast, break tea while also selling beverages, consumables and milky products. Her business has managed to pay back the loan, and she is reaping from the investment. Her future plan is to expand the business by getting another loan from the scheme:
Hospital Secretary (Nassali Prossy) has managed to buy a plot of land and put up a personal house from multiple loans she got from the scheme. Her dream is to say goodbye to renting by use part of her house as her home and the other part as rentals for hire so that she can save from paying her rent as well as earn some extra income from her tenants
Staff have accessed loans from the scheme for school fees for their children at primary, secondary and tertiary institutions.
Staff Mambu Miriam (A social worker) is one of the scheme members who has benefited by accessing school fees loan from the scheme for her children:
Salary Accountant (Ms. Nakavuma Annet) with her five children strives to educate them at Broader Vision nursery & primary school Kawoko-Kampala through accessing school fees loan from the scheme. She highly appreciated the contribution of the scheme that if it were not the scheme, probably her children would not be schooling:
Staff have accessed loans for their own fees while at upgrading level tertiary institutions especially enrolled nurses who upgrade to registered status as well as for further courses like public health etc.
Hospital Community Mobiliser (Kizza John Baptist) is grateful of the financial support extended to him through accessing loans from the scheme. He says that after the untimely death of his guardian & brother in a motor accident, his education was in a mess. But with the help of the hospital scheme he has managed to complete a degree in community psychology from Mutesa I University:
Deputy Senior Nursing Officer (Sr. Catherine Nakajiri) is currently undertaking a degree in public health from Mbarara University of Science and Technology. Her basis of tuition are the multiple loans she gets from the hospital scheme:
Home improvement: Many staff have secured plots of land, renovated their houses, and constructed homes for their families.
Rev. Sr. Maria Goretti Namuwulya(Hospital Administrator) is so thankful of the contribution of the scheme towards the development of her home. She got multiple loans from the scheme from which she managed to construct a home for her parents & relatives.
Hospital anaesthetist (Ms Josephine Kayondo) has managed to renovate her house as well as constructing rentals from the finances she has borrowed from the scheme. She says that the scheme has enabled her achieve her dream of becoming a landlord with over 10 tenants who pay her an extra monthly rental income.
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.
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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.
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.
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.
Jim McWhirter July 2017
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!
Visit report July 2016
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
Visit to Uganda January 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