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
Bristol University medical school has sent 4th year medical students for SSC study in Uganda each year since 2013. Twenty students and four tutors arrived for a three week stay at Kitovu and Villa Maria hospitals
Rotary District 1090 has sent a Vocational Training Team (VTT) to Kamuli Mission Hospital for the fifth time. They have trained midwives, nurses and doctors in essential life-saving skills for mothers and babies. Death rates for mothers and babies have fallen significantly since their first visit in 2014.
Kumi hospital is the second one to receive an orthopaedic drill donated by Rotary Doctor Bank. Most hospitals are only have hand drills which make operations a lot longer and therefore less safe for the patient. The drill has been developed by Arbutus Medical in Vancouver, Canada. It is a non-profit venture in collaboration with the University.
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!
This visit was a very rewarding trip as the patience, hard work and generosity of so many of you is now bearing real fruit on the ground.
The maternity ward and the old operating theatre at Kamuli are both being refurbished and extended.
This has been made possible with the support of many individuals and Rotary Clubs, a large private donation, the Uganda Childbirth Injuries Fund, Rotary Doctor Bank, fundraising by Dr Philip Unwin of Henley, and a Rotary Global Grant.
At the same time a Rotary Vocational Training Team was teaching lifesaving skills at the School of Nursing and Midwifery.
After Kamuli I visited ten other hospitals, being driven 1350 miles by my Ugandan friend and colleague, Dr Rogers Kabuye of Medicaudit.
Some of these are hospitals which have been using the Medicaudit management system for some time and where it has produced very real financial benefits.
We were seeing other hospitals to assess their suitability for using the system.
By increasing management efficiency and use of resources, Medicaudit increases hospital income without the need to increase patient fees which is very important as most patients are poor subsistence farmers.
We have embarked on a programme to install Medicaudit in 30 – 40 hospitals over the next few years. The team has been expanded to cope with the extra work and the whole project will be self funding in five years time as hospitals pay a fee for ongoing maintenance and support. In the meantime your donations will support this critical work which is enabling hospitals to save lives by working more effectively with extra funds for staff, equipment and buildings. For the next two years all donations to this work will be matched fully by a very generous private donor up to a maximum of £20,000.
Examples of benefits from using Medicaudit that we saw are are shown below and were both purchased from their own savings and without donor help.
New staff quarters at Villa Maria.
A new X-ray at Nkozi
You may recall that Kilembe Hospital lost all their staff quarters in a flood in May last year. It was very gratifying to see how we had refurbished a previously burnt out house to provide accommodation for four nurses.
Thanks to all of you who have helped to make all this possible.
To make a donation which will attract gift aid and a full matching increase, follow this link to Virgin Money Giving by clicking here