Uganda: Healthcare Implementing Partner for UNHCR at Bidibidi Refugee Settlement
Ebola Preparedness Training Conducted: Q4 2018
March 05, 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 was 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 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.
- 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 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.
- 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 was given recognition by the district officials and granted the extra responsibilities of Assisted Partner Notification (APN), a very specific and sensitive method that takes a lot of preparation and professionalism. In the previous quarter, we were able to trace, test, and counsel 18 partners and also link them to care with a lot of precaution. This has improved our HIV/AIDS prevention strategy.
- Continued to facilitate the disease surveillance teams’ activities so that the medical department will not be taken by surprise in case of an outbreak. 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. As we had registered a number of maternal deaths during this reporting period, the Reproductive Health Officer, together with the District Health Team, conducted supervision throughout the facilities, a routine done every Thursday and Friday to support the maternity services. In addition, malnourished pregnant and lactating women benefited from nutritional foods and education.
- 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 from developing multidrug-resistant tuberculosis (MDR-TB).
- Continued to support government facilities with medical supplies and staff to assist with the high volume of patients referred from the refugee community. We have also deployed another RMF staff member to support Barakala Health Centre III, a government facility to which we submit our monthly and weekly HMIS reports from zone 1 facilities.
- Our staffs were involved in different capacity-building trainings and refresher courses to enable them to stay updated in the medical field, which is very dynamic and ever-changing. From October 15-19 we had a TB/HIV reporting training in Dhis2 (a software used by the government). Data clerks, data managers, and HIV focal persons from the different zones were trained in order to have clean data captured and reported to avoid errors in the database. We also held a TB, HIV, and nutrition review meeting, in which a number of issues were discussed, such as the issue of feeding TB/HIV malnourished patients with RUTF (ready-to-use therapeutic foods) supplements given that the WHO (World Health Organization) threshold still stands at less than 5 years.
- There has been ongoing progress of construction of two staff houses at Bidibidi Health Centre with the support of RMF. One of the commitments made to UNHCR was to construct a staff house in addition to already existing UNHCR constructions, and we are steadily progressing to meet that commitment.
Conducted 108 integrated outreaches during the reporting period. Out of the 9 health facilities currently running, each is expected to conduct 4 outreaches every month. Regretfully, one of the original 10 facilities was closed in Zone 4 on the recommendation of UNHCR due to insufficient funds to run all the facilities. This tenth facility is now running as an outreach post, as advised.
Supplementary Nutrition Program
Caring for Mothers
The nutrition department continues to fight malnutrition in Bidibidi Refugee Settlement through the implementation of a supplementary nutrition program and nutrition education for pregnant and lactating mothers, as well as through the rehabilitation of malnourished children at the inpatient therapeutic care points. During this reporting period, the nutrition team identified and managed 3 outstanding nutrition cases under ITC (Inpatient Therapeutic Care) aside from the routine OTC and SFP care administered on a daily basis. There is still need for outside intervention regarding this concern.
We successfully conducted 835 deliveries during the reporting period. We registered the crude birth rate at 5.7 and the proportion of deliveries attended to by a skilled health worker at 94% against the standard of 100% (however, this is an improvement from 91% in the previous reporting period). This is a result of mothers who wait to come to the facility after labor begins or who wait too long to call an ambulance in the event that the mother is in a critical state and cannot make it on her own to the facility.
Participating in Child Health Days
Bidibidi Refugee Settlement promoted the immunization program in all zones under the management of RMF (1, 3, and 4), and the program was carried out at both outreach and static posts. With support from RMF and UNHCR, we were also able to fully participate in the Child Health Days (Child Days Plus) this month.
World AIDS Day
Participating with Partners
We participated in the World AIDS Day celebrations on December 12, organized by the Yumbe District local government. In partnership with the other implementing partners and in collaboration with the Yumbe District local government, the celebrations took place in Zone 4, Odravu Subcounty (catchment area for Bangatuti and Igamara RMF health centers). Our staff provided emergency health support during the celebrations in addition to HIV/ AIDS counseling and testing and the moonlight activities before the event.
Training Medical Staff
In partnership with UNHCR, with funding through IGAD, we conducted training in Ebola preparedness for the medical staff, primarily with regard to prevention, detection, and treatment. Trainees were later awarded with certificates as evidence of the training which will also assist in their future ventures.
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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Age: 4 months
Musa was a preterm baby, born at 30 weeks, with a very low birth weight (VLBW), to young parents (teenagers). Musa weighed 0.9 kg (900 g) at birth, had no suckling reflex, and was being fed using a nasal gastric tube.
Musa’s mother, being a young parent (17 years old), had a lot of psychological trauma and wasn’t freely breastfeeding the baby. She was given psychosocial support through sessions of counseling as well as nutrition education and was enrolled in the MCHN program. Her breast milk supply increased and she was able to express milk for the child. After the child had gained the suckling reflex, the mother was discharged and encouraged to return on weekly basis to weigh the baby and review, which she did.
Musa’s weight has increased tremendously, and the child’s mother is overwhelmed with joy. Musa’s latest visit was on February 11, 2019, when he weighed 4.7 kg. His next visit will be on February 25. Musa is exclusively breastfed and has registered a very great improvement.
Age: 19 months
Hanan was identified during a screening outreach in Block 11, presenting with severe bilateral pitting edema and severe dermatosis. According to the parents (Abdul and Sauda Taban), Hanan had recurring episodes of malaria and had been treated at Iyete Health Centre III. The parents had a misunderstanding and the mother returned home with her, and on returning to the settlement, Hanan’s condition had worsened. The parents in their culture had some superstitions that due to the anger the mother had with the father, she poured hot water on the ground, which speaks badly to their culture, which brings Hanan as a sign. They had prepared to slaughter a sheep to break the spell/curse when they went to seek medical attention in an outreach in Block 11. Here they were referred to and admitted at Bidibidi Health Centre III for ITC management on December 23, 2018.
Hanan was triaged with: Weight = 6.5 kg, Height = 71.0 cm, Z-score = <-3 SD (Standard Deviation) (SAMO+++), and severe dermatosis. The parents were counseled on hygiene and on the use of the therapeutic foods, i.e. F-75, F-100, and RUTF. The child was started on F-75 2hrly, and given antibiotics. She was then transitioned to F-100 after she had stabilized (i.e. the edema subsided). She was discharged on January 4, 2019, to Iyete Health Centre III, where she was managed on OTC with RUTF.
On February 6, 2019, Hanan was discharged to SFP with: Weight = 8.3 kg, Height = 71.6 cm, Muac = 13.5 g, Z-score = >-1 SD (Standard Deviation).
Hanan has registered a great improvement.