Uganda

The success of our acupuncture and malaria programs in the Kiryandongo Refugee Settlement in Uganda has lead Real Medicine to another opportunity to support the primary health care available in the area.

Situated just outside of the settlement is the Panyandoli Health Care Clinic, which provides care to the more than 16,000 refugees and IDP’s (internally displaced people) the region. In an agreement with the Ugandan government and the UNHCR, RMF, with support from World Children’s Fund, will upgrade all in patient wards, provide rain water collection, a computer for reporting, medical supplies, cooking stations and will investigate the installation of solar power to bring electricity to the center. Our plans are outlined below.

An integral part of our project will be to foster a sense of community pride and ownership among the Ugandan IDP’s and the Kenyan and Sudanese communities for the facility. Mutual respect among the communities for one another, and for the services that donors are providing, will be the cornerstone of the center’s success. In light of this we wish to involve volunteers from all the community to perform cleaning, painting and general repair tasks and upkeep etc. Mr. Solomon Osakan, Settlement Commandant from the Office of the Prime Minister and Rehma Kauma, Protection Officer of the UNHCR felt that community involvement was an important component to our collective efforts to upgrade and maintain the facility.

Below are excerpts from my Uganda trip report documented February 8th through February 15th 2009 which would not have been possible with out the support of our Project Coordinator, Charles Naku and Dr. John Njoroge who oversees our acupuncture program at the settlement.

Background:

The Panyandoli Health Center, located at the Kiryandongo Refugee Settlement and previously funded by the ICRC, serves a community of over 16,000, comprised of approximately 10,000+ Ugandan IDP’s, 5000+ Kenyan and Sudanese Refugees.

There are eight separate buildings, including wards for: Malnourished, Antenatal, Maternal, Children, Adult Male, Adult Female, In Patient and a Laboratory. There is also a well on the compound.

The primary conditions requiring medical treatment at the center are:

• Malaria*
• Respiratory Infections
• Intestinal Worms
• Sexually Transmitted Disease (HIV/AIDS)
• Trauma/Domestic Violence
• Psychological Trauma (PTSD)*

* RMF is currently supplementing Health Center Support through its Homeopathic Malaria and Acupuncture Programs based within the Refugee Settlement. At the time of this report there were no cases of Malaria at the Health Center. This is quite unusual according to village residents.

It was estimated that during peak treatment seasons (rainy season), the number within each ward run at approximately 15/ children’s ward, 10 each,/Adult Wards.

Other Health Center Offerings:

• In/out patient services
• Health education – Protecting families with HIV – Family planning
• Health Team field visits for Health Education
• Specialized Dr. comes generally once a week

Real Medicine Foundation Provisions:

We greatly appreciate the scope of your needs to better serve the community and the time you have taken to prepare and convey them to us. Our intent is to first address areas of priority that directly impact the hygiene of the center and the quality of care being provided to the community, which you have estimated at over 16,000 including Ugandan IDP’s and Kenyan and Sudanese refugees.

Medical Supplies: The list below is not a comprehensive list of the Health Centers needs.

Medicine – We are aware that you obtain medicine from the government every 2 months and from the UNHCR every three. Real Medicine will serve as a third source to bridge any gaps in delivery from your primary sources so that the center is never without necessary or emergency medicines.

We will also provide the following medical instruments to facilitate more thorough intakes and assessments of the patients. Fulfillment of all items will depend on our available funding.

• Baby Scale
• Adult Scale with Columns
• Stethoscope – Children’s
• Stethoscope – Adults
• Thermometers
• Digital blood pressure cuffs
• Digital blood pressure gauges
• Examinations Equipment – reflex hammers, tongue depressors, etc
• Ears Nose and Throat Kits
• BTL Set, STS Set, DNC Set
• Implant Insertion Kits: Trocha and Camilla (please confirm this information)
• Dressings and Antiseptics
• Soaps and Disinfectants

All equipment purchased by RMF will be identified with our logo and/or as “Property of Real Medicine Foundation” on the unit itself and maintained in a separate capital equipment inventory. These items are not to be removed from the center for any reason unless authorized by RMF project coordinator, Mr. Charles Naku.
 

Health Management Information Systems: HMIS

Orphaned at Birth

To upgrade the data maintenance at the facility, RMF will purchase a computer with MS Office and a printer. This will also improve the ease and timeliness of report generation required by RMF and its donors, The Ugandan MOH, and the UNHCR. The Health Center will provide RMF with at least monthly morbidity and mortality reports via email and hard copy, based on the UNHCR HIS v1. 4.00. The Health Clinic will clear with the UNHCR that they are authorized to furnish RMF with this file. RMF will address information sharing in the MOU.

Real Medicine Foundation will provide salary support directly to a selected trainee to apprentice under Michael to learn the computer based data Health Management and reporting system of the Panyandoli Health Center to prevent a gap in efficiency in his absence or in the event of his transfer.

Some stationary, pens, office supplies, markers, folders, filing and storage/filing cabinets will also be provided. The permanent items (computer, printer, cables, and cabinets will be marked with the RMF Logo and/or as “Property of Real Medicine Foundation” on the unit itself and when possible maintained in a separate capital equipment inventory. These items are not to be removed from the center for any reason unless authorized by RMF project coordinator, Mr. Charles Naku.
 

Faces of the Children at Panyandoli Health Center

Facility Upgrade Implementation:

Rain Water Collections

RMF will purchase gutters for the In/Outpatient and Antenatal buildings and place a plastic container between the two buildings to collect water. The tank will have both the Real Medicine Foundation and World Children’s Fund Logos on it.

Electricity/Power

It is the intent of RMF to assist in providing a solution in part or entirely to the power needs of the core activities of the Health Center. We have considered Solar Power, Generators and having the electric lines run to the Health Center. The method of resolution is not yet decided.

Inquiries are pending on the electrical requirements of the facility. Mr. Simon Opieto is contacting a technician for this assessment. He will advise Michael Lear, RMF of the determination (electrical requirements/ward/building). The technician will also project costs to bring the phone line to the Health Center, including pole costs and laying the wire.

Solar Power

Mr. Francis Semwoge of the UNHCR explained that GTZ has already done a comprehensive needs assessment for solar power. He is currently trying to obtain this report. RMF will contact GTZ and inquire about partnering to facilitate the installation of solar power jointly.

Gas Generators

Gas generators are costly to operate long term. However they can be an effective method of providing short durations of energy if necessary. The current generator provided by the UNHCR is adequate for operating a computer and perhaps a printer. RMF will provide a fuel allowance for operating the generator in this capacity. The amount is yet to be determined.

The specific areas of support will be outlined below and coordinated with our Project Manager, Mr. Charles Naku. You may also speak directly with Mrs. Beth Cole, our Ugandan Country Director or contact me directly. Your assistance in obtaining information about expenses is greatly appreciated.

Structural Upgrade of the Facility

Real Medicine Foundation will provide paint and supplies for interiors of each ward including:

* Mattress quantities are based on maximum patients per ward during high admittance months//through the rainy seasons often related to malaria as estimated by Mr. Michael, following an assessment of in patient history.** Sheet sets are for parents who were unable to bring sets or do not have sets for stay at center. (Sheet/Cover/Blanket)
*** Spray Paint if possible

Please note that the above figures are initial estimates and are subject change.

Notes:

We have quoted white paint for the walls and are looking for quantities of blue for the window and doors. We are aware that some of the ceilings will also require minor repairs and we can support this as well. (In particular there seems to be a roof leak in the antenatal ward.) Again, if there are refugees willing to volunteer their time we will facilitate this through Peter Karajna, camp leader.

We suggest that cleaning supplies are always on hand in each ward/department and the each week a thorough cleaning is undertaken by one of the camp volunteers. This job can rotate weekly. Following the painting of each ward, the Health Center Staff can coordinate a health education class to discuss cleaning feet prior to entering the Wards – personal hygiene…

Charles Naku our Project Coordinator will procure the supplies necessary to clean each ward, and paint the interior walls and interior doors in white and blue respectively. Cleaning supplies will be marked as RMF property and kept on hand in each ward for regular cleaning.

Notes Cont’d:

The children’s crib beds will also be painted, approximately 15. There are a number of broken crib beds and beds in each ward. We suggest these be move out of the wards into storage if they can be repaired or disposed of if irreparable.

With the reduction of crib beds in the children’s ward we suggest to bring in 4-6 adult beds for the parents who stay with the children.

• An inventory of existing mattresses that are in very good condition should be taken. Any damaged or torn mattresses should be removed from the wards and stored.
• Some of the window netting of the wards are torn. An inquiry needs to be made about screen costs to repair.
• Our intent with removing unused or damaged beds is to create an open and clean appearance.
• We recommend Hygiene education follow the cleaning and painting – i.e. cleaning feet before entering.

Malnutrition Ward Support:

Quotes for kitchen structures to support the malnutrition ward and other wards will be obtained and RMF will provide – the former is most important and will be constructed first. A secondary structure may be built if funding is available. Some cooking ware may be provided. Cleaning supplies, detergents, etc will also be supplied.

If funding is available Real Medicine Foundation may be able to offer support to rebuild the fallen structure in this area.