Uganda: Panyadoli Healthcare Project

Project Goals:
Upgrade and maintain the Panyadoli Health Care Centers at a high level of hygienic and operating standards.

Project Objectives:
 
Health status of the population improved through:

• Provision of medicine, medical supplies, and medical support
• Support service delivery through employing medical personnel.
• Supporting and maintaining the security of the health centres through employing security guards.
• Reaching communities with health services through community outreaches
• Raising health service awareness through health promoters and community health teams
• Support of the Health Management Information System Maintenance (staff and petrol supply)
• Maintenance of hygiene at health centers to Best Practice Modern Medicine standards
• Enhancement of existing structures for Malnutrition Ward and Main Center
• Promotion of hygiene through recruitment of more compound and ward cleaners.
• Upkeep and renovation of the health center through periodic re-painting and re-plastering.
• Maintaining effective disease surveillance through community health services
• Maintaining a high level health information system  

Summary of RMF/WCF-sponsored activities carried out during the reporting period under each project objective (note any changes from original plans):

• RMF provided the Panyadoli Health Center III with medicines and medical supplies, and covered all existing gaps during this reporting period, including a continued increase in the quantity needed due to the new influx of South Sudanese refugees. Medical supplies were also provided to Panyadoli Health Center II and the Reception Centre Clinic.
• Supported important events for the refugees programme which included: World Refugee Day, Day of the African Child, World Cancer Day.
• Facilitation to attend UNHCR and partners’ coordinating meetings both in the settlement and regional offices, helping to promote cohesiveness in operations. 
• In July 2014, RMF signed a tripartite Agreement with the United Nations High Commissioner for Refugees (UNHCR), and Office of the Prime Minister (OPM) for RMF to be the official Implementing Partner for health at the Kiryandongo Refugee Settlement for UNHCR/OPM for three health centers and a large community outreach program.
• Recruited and inducted new staff members to support and accomplish core tasks for the project: Pharmacy Assistant, Pediatric Nurse HIV/AIDS, HIV/AIDS Senior Counselor, Community Health Assistant, Head of Finance and Administration, and Finance Assistant.
• During this reporting period RMF’s medical team escorted the convoy of Kenyan refugees during the dignified repatriation exercise. The RMF team provided medical support in terms of first aid and provided ambulance services.
• Facilitated staff on mission: accompanying patients on referral, coordination meetings and routine supervision.
• Conducted massive immunization and HIV/AIDS awareness campaigns.
• Support of 6 interpreters, and 80 Village Health Team members for community outreach.
• Procurement of proactive gear for cleaners and security officers.
• Sustained water supply at Panyadoli Health Centre III.
• Continued maintenance of water pipes and solar pump at Panyadoli.
• With additional funding from UNHCR, RMF is able to buy supplementary drugs to individuals with complicated rare cases; the drugs needed for these patients are costly and cannot be easily found in the health centers.
• Six ward cleaners and four groundskeepers sponsored by RMF groomed the grounds regularly and made sure the cleanliness of the wards and offices was well maintained. 

Results and/or accomplishments achieved during this reporting period:

• Continued provision of medical treatment and other health services to patients and quarterly provision of medicines and medical supplies have kept Panyadoli Health Centre III, II, and the Reception Centre Clinic running effectively especially during the current massive influx of South Sudanese refugees.
• Successfully conducted the physical verification exercise with UNHCR, and RMF received a positive report from UNHCR.
• As a result of paying salaries to the ward and compound cleaners, the sanitation of the health centres has been excellent. Both wards and compounds are clean.
• The grounds are continuously cleaned and maintained, making it safe to walk around without fear of being bitten by snakes.
• The Solar Powered Water Pump is continuing to run successfully, providing clean running water to the clinic wards and offices, and greatly increasing hygienic conditions of the health centers

Number served/number of direct project beneficiaries (for example, average number treated per day or month and if possible, per health condition).

• 14,721 patients were treated during the 2^nd Quarter of 2015.
• 6,182 were male patients and 8,539 were female. 
• 9 deaths were reported at the health centers during this quarter, patients dying of SAM, Anemia, Malaria.

Notable project challenges and obstacles:
 
South Sudan Refugee Crisis in Uganda/Kiryandongo
 
Despite the cease-fire and discussions to end the South Sudan crisis, no agreement has been reached and fighting has continued. The implication of this is that more refugees will keep coming. This requires continuous and additional funding to provide services that will match the increased population of refugees.  Currently, we receive over 80-100 refugees per day. 
 
Delays in PHC funds as the government doesn’t follow the quarterly releases and low funding (5,000,000/= per year). Inadequate staffing results in delays in blood screening which affects time taken to access treatment by the patients. Delays in accessing services at Kiryandongo Hospital due to language barriers and lack of a referral focal person. Lack of treatment for chronic diseases, especially high blood pressure.
 
Lack of treatment for chronic diseases, especially high blood pressure.
 
The laboratory block has multiple cracks and needs renovation to ensure safety of staff and patients.
Lack of a psychiatric nurse at the health centre, hence high referrals.
 
Lack of delivery sets (consisting of kidney dishes-big; artery forceps; cord scissor; sponge holding forceps and gallipots-medium) both at Panyadoli Health Centre III and Kiryandongo Hospital.
 
Lack of episiotomy sets (consists of 2 kidney dishes-big, 2 artery forceps, cord scissor, sponge holding forceps, needle holder, episiotomy scissor, dissecting forceps and gallipots-medium).
 
Lack of stitch removal sets (2 kidney dishes-small, 2 gallipots, 2 mosquito artery forceps, stitch scissor and dissecting forceps).
 
Lack of dressing sets (2 kidney dishes-small, 2 gallipots-small, 2 dissecting forceps, and mosquito net).
 
Lack of MVA sets
 
Lack of ambu bags (neonate).
 
Solar for maternity, theatre and 4 wards needed.
 
Fetoscope (plastic) needed.
 
Inadequate number of medicine trolleys.

APPENDIX A
 
Success Stories
 
Daniel Nansasira
 
Daniel is a 1-year-old boy from Panyadoli B. Daniel was diagnosed with malnutrition at Panyadoli Health Centre III where the doctor and the medical team took action first and initiated several procedures and put him on outpatient therapeutic treatment plus plumpy nut. Daniel’s mother said that they came to the health centre when the boy was in a very bad condition, with his whole body swollen. Daniel could not eat but after 2 days at Panyadoli Health Centre TFP, Daniel started eating food and milk after introducing him to F75 and F100 at the centre.  Daniel was also diagnosed with malaria. It currently being rainy season; malaria in general is a major threat to young children since in most cases families lack mosquito nets to help them prevent the disease. Daniel was treated, and after 2 weeks in our health centre released in good condition.  Daniel’s mother was taught how to use mosquito nets and was given one for free, thanks to RMF/WCF.  Daniel and his mother left the health centre with big smiles on their faces.

Daniel with his mother, waiting for their discharge
 
 
Janette Kwisiny
 
Janette is a 1-year-old girl from Bweyale town council. As a result of the continuous outreach programs done by the RMF medical team, Janette was amongst the children that were identified in the community.  When Janette was brought by her mother to Panyadoli Health Centre III, she was diagnosed with malaria, and according to the doctor at the centre, Janette was also suffering from malnutrition and a bacterial infection. Janette was treated with Amoxicillin and therapeutic milk F75 and F100 plus IV Artesunate, IV Ampicillin, and V Gentamicin. Janette was discharged in good condition.

Janette with her mother on the day of her discharge
 
Mildred Lakesa
 
Lakesa is 1 year and 7 months old. Lakesa and her family live in cluster A within the settlement. Her mother said that she brought her daughter when the skin of the girl had started changing, experiencing rushes, and the appetite of the girl had disappeared, after proper check-up from our RMF doctor at the health unit, Lakesa was identified with acute malnutrition which has become common for the children in the settlement due to an unbalanced diet. Very often these children depend on only one type of food as their mothers also lack enough food for themselves to generate enough breast milk. The girl was put on IV Ringer’s Lactate, IV Gentamicin, IV X-pen, and IV Artesunate With this treatment Lakesa showed great improvement. She was given supplementary feeding as well.
The skin rushes have disappeared, and as of now Lakesa’s skin is smoothing out as she is getting better and better, and her mother is excited to see that her child has improved tremendously.  She gives thanks to God and the RMF medical team.

Lakesa on her mother’s lap
 
 
 
Otim Kisa Kenneth
Otim is 9 months old, from Mutunda, born into a family of 15. Otim fell victim to a poorly balanced diet, exposure to mosquitoes, and to competition for food in his family as his mother did not have enough milk to feed the child. The only available food for Otim was porridge. He started to develop a severe skin condition. Otim came to our health centre severely malnourished; with a respiratory tract infection, and with malaria. He was put on IV Ampicillin, IV Gentamicin, IV Artesunate, and Diclofenac injections, as well as IV Dextrose 5%. Otim was also given therapeutic milk, F75, F100 to help him gain weight, and to develop an appetite thus improving his health.  RMF’s outreach programme has helped a lot of children such as Otim. They often get forgotten in the community, and their mothers do not bring them to the health centres out of shame. 

Otim at the health centre