Uganda: Healthcare Implementing Partner for UNHCR at Bidibidi Refugee Settlement
ART Clinic Registers Growth: Q1 2019
May 06, 2019
Naku Charles Lwanga
Summary of Activities
- Continued to provide high-quality health services to persons of concern through the Outpatient department, Inpatient department, inpatient therapeutic care, outpatient therapeutic care, community outreaches, and referral services.
- Throughout the reporting period, RMF purchased and delivered medicines to the health facilities on a monthly basis to treat patients. RMF also purchased laboratory supplies to test for diseases. Medicines and testing helped save lives.
- During the reporting period, technical issues delayed the procurement of the medicine and medical supplies from UNHCR. However, the supply of medicines from RMF were able to keep the facilities running and manage the patients’ conditions.
- Food supplements were procured to support the nutrition program.
- RMF provided a constant flow of cleaning supplies, which enabled our diligent sanitary team to keep health facilities clean. The cleanliness of RMF-managed health facilities is among the reasons why many patients prefer receiving care from us.
- Treatment was provided to all patients that came to the health facilities. Patients with conditions that could not be handled at the health facilities within the settlement were referred to district and regional referral points, respectively.
- Continued managing highly motivated medical and support staff teams to provide optimal care to the patients.
- Salaries and wages for RMF-supported staff were paid in a timely manner, which helped keep staff members motivated.
- RMF has continued to provide a medical team during emergencies at the Goboro border point, providing medical services to refugees who arrive exhausted.
- RMF has continued to sustain medical staff that were hired to support health centers neighboring Bidibidi Refugee Settlement. This has helped reduce the constraints felt in these health centers due to the dramatic increase in population and is contributing to peaceful coexistence between the refugee and host populations. District health facilities benefiting from this program include Yumbe Hospital, Barakala Health Centre III, and Kulikulinga Health Centre III.
- RMF continued to facilitate and manage routine immunization exercises in zones 1, 3, and 4 of Bidibidi Refugee Settlement. All the under-5 children arriving at the settlement are also immunized. This is a strategy to secure the future of these children, which is threatened by deadly diseases. The program was carried out at both outreach and static points.
- Continued to facilitate the disease surveillance teams’ activities so that the medical department will not be taken by surprise in case of an outbreak, specifically of ebola from the DR Congo. Any suspected samples of cholera, measles, and polio are rushed to the national laboratory for confirmation. This is partly why no outbreak was experienced during the reporting period.
- Community health officers and Village Health Teams (VHTs) were trained on community-based disease surveillance, patient referral, and health promotion strategies.
- RMF facilitated community leaders’ dialogues to help community leaders become ambassadors of good health practices. This will strengthen the preventive health initiative and thus reduce the cost of curative health.
- Continuous cervical cancer screening and education is ongoing at the health facilities.
- All RMF-managed health facilities continued to provide antenatal, maternity, and family planning services, thus promoting institutional deliveries and safe motherhood, as opposed to village-based deliveries. We have been able to achieve safe motherhood targets, thanks in part to the dignity kits provided by UNHCR and distributed by RMF at the health facilities during delivery. In addition, malnourished pregnant and lactating women benefited from nutritional foods and education.
- During this reporting period, we participated in the multi-antigen campaign, which took place in three phases, for mass vaccination of children and young adults within the refugee settlement and nationals from the host community as they came in.
- Conducted follow-ups on TB cases in the community to ensure that patients are taking their medication as instructed. Through outreaches and home visits, we are working to prevent patients developing multidrug-resistant tuberculosis (MDR-TB).
- During the reporting period, the nutrition department engaged in community activities and integrated outreaches. In March they also conducted a mass MUAC screening; the report hasn’t yet been released.
- Throughout the reporting period, pregnant mothers benefited from nutrition services.
- Continued to support government facilities with medical supplies and staff to assist with the high volume of patients referred from the refugee community.
- Our staffs were involved in different capacity-building trainings and refresher courses to enable them to stay up to date in the medical field as it is very dynamic and continually changing. Training such as the BMOC (Basic Maternal and Obstetric Care) was to prepare them for the transition from the EMOC (Emergency Maternal and Obstetric Care), which was used during the emergency phase of the settlement.
- Under the ReHoPe project for the host community, we continued to provide ambulance services to the persons of concern as well as support to the health system in the district.
- The Bidibidi program continued to provide the special investigation services of X-rays and ultrasound scans to the persons of concern, services which are not readily available in the refugee settlement and are therefore done at an extra cost to RMF through another service provider.
- Through RMF, we provided meals to persons of concern at the referral points with three meals every day for a patient and a caretaker until their hospital stay ends. This is because sometimes the persons of concern who have been referred to government hospitals are unable to find food.
- An audit for the Bidibidi operation of 2018 was conducted, and we are waiting for the report from UNHCR. The audit took place at the Real Medicine Foundation head office in Kampala.
- We undertook renovations of the facilities that are still temporary, especially the Luzira Health Centre, as they had been damaged by the wind.
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Aiding the Community
Staff continued conducting community health outreaches to extend medical treatment and health education to the community, especially to people of concern in more distant villages of Bidibidi Refugee Settlement. 96 integrated outreaches were conducted during the reporting period. Out of the 8 health facilities currently running, each is expected to conduct 4 outreaches every month.
New Isolation Unit
Reducing Infection Rates
In order to help us mitigate the infection rates within the settlement, Bidibidi Health Centre III received an isolation unit to assist in isolating the highly infectious patients from the medical patients on the wards.
ART Clinic Growing
RMF continued to provide HIV/AIDS testing, counseling, and ARV services and encourage all patients to practice healthy lifestyles. The team also continued to trace patients who were previously on ART and work to reinstate them on treatment. The ART clinic is growing.
Encouraging Proper Nutrition
We organized cooking demonstrations in the community, which were spearheaded by the nutrition department to encourage mothers on good practices of feeding their children and also to identify nutritious foods that are affordable by all and readily available.
RMF continues to promote the peaceful coexistence of refugees and nationals through the provision of integrated healthcare services, creating strong linkages, and harmonizing operations with district local government. During the reporting period, refugee and host communities continued to interact peacefully.
HIV/AIDS Awareness Program
Staff boosted the HIV/AIDS awareness program in the community; awareness was promoted among school-going children during the reporting period. HIV prevention activities included the distribution of condoms, moonlight counseling, testing, and sensitization. In addition, the ART clinic conducted an HIV/AIDS awareness week in the settlement as a step to fulfill the 90-90-90 policy of the Ministry of Health.
Since 2009, RMF has been working to help the people of South Sudan recover from decades of civil war, which destroyed much of the country’s infrastructure and healthcare system. RMF initiated, co-founded, and continues to support the Juba College of Nursing and Midwifery, supports the Juba Teaching Hospital, and in December 2014, became the UNICEF implementing partner for malnutrition treatment and prevention in Jonglei State and the greater Pibor Administrative Area. Even after renewed fighting broke out in July 2016, RMF’s in-country teams have continued these programs. RMF has also been providing health services, school support for children, and vocational training to South Sudanese refugees in Uganda’s Kiryandongo Refugee Settlement since 2008, and was appointed UNHCR Health Implementing Partner in 2014.
To accommodate the large numbers of South Sudanese refugees fleeing to Uganda (between July 1, 2016 and September 21, 2016, there were 163,540 new arrivals), the Ugandan Office of the Prime Minister (OPM) and the UNHCR, in partnership with RMF and other organizations, opened the new Bidibidi Refugee Settlement on August 5, 2016. Bidibidi is located near the South Sudanese border in the Yumbe district of West Nile, Uganda, and has the capacity to support 180,000 refugees. Bidibidi is being built from the ground up, and during August 2016, 31,902 refugees were relocated to the settlement. Real Medicine Foundation is the main UNHCR Health Implementing Partner for Bidibidi Refugee Settlement, and between August 5, 2016 and August 31, 2016, 5,331 patients were treated at RMF’s health clinic.
- To provide residents of Bidibidi Refugee Settlement with high quality primary health care
- To maintain easily accessible, fully staffed, fully stocked health clinics
- To provide referrals to secondary and tertiary care centers when needed
- To provide health education and early detection through health outreaches
- To provide support to Yumbe District Hospital
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Host Community and Refugees
- 278,000 refugees
- Over 160,000 people in the host community
Eunice Poni was born on January 15th, 2019, at Bidibidi Health Centre III at 2.5 kg with no sucking reflex. She, therefore, contracted infections and was given antibiotics and Bidibidi Health Centre III, where she was delivered and admitted. The mother’s breast milk was expressed and fed to the baby through the NG tube. Later, the mother’s breast milk flow reduced and the nutrition team supplemented it with SDTM (Specially Diluted Therapeutic Milk). However, the child kept deteriorating, her weight dropping to 1.6 kg. The RMF medical team conducted all the necessary tests on the child but found nothing wrong with the baby. The baby was then retained on the ward for one month and was then referred to Arua Regional Referral Hospital. The team there continued to feed the baby with SDTM and formula since the breast milk supply was exhausted. The baby was returned after 2 weeks to the health center in the settlement and she had improved tremendously, and we resumed lactating. The child has improved, and by the end of the reporting period, the child was 3 kg the last time she was brought in for a follow-up review.
Lucy Kiden was born on March 3rd, 2019, at Iyete Health Centre III, and later referred to Bidibidi Health Centre III. The baby’s mother did not have enough breast milk to breastfeed the newborn baby, and upon realizing that the child’s weight was deteriorating, we began supplementing with SDTM (Specially Diluted Therapeutic Milk); dilution of F100 to feed children under 6 months. Meanwhile, the mother was taught positioning and attachment and was given nutrition education. She was enrolled in a supplementary feeding program until the milk supply increased, and the SDTM was gradually withdrawn. The photo below is of the baby after intervention and discharge. The baby had been brought back for immunization and follow-up of the supplementary feeding program at about 3 months.
Moses Candiga, a national from the host community, was identified by one of our VHT members in Lomunga Village, which is also within the catchment area of Bangatuti Health Centre III in Zone 4. The baby was brought to the health center on February 19th, 2019. On examination, the team identified that the child had a swollen stomach, and was admitted with Grade 2 edema. Moses comes from a family of more than 7 children, and his family solely depends on the mother for food, which is sometimes not enough for all of them. The team suspected this to be the cause of the malnutrition of Moses, who had delayed milestones; at 1 year and 7 months, he could only sit. The child was managed on F75 for two weeks and was later transitioned to F100 when the edema subsided. Later on, Moses was also enrolled on RUTF when he had improved. The RMF health and nutrition team later discharged him after one month of intervention at the health center and shared good feeding practices with the mother to keep the baby healthy and achieve milestones.
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