Environmental Sanitation of St. Mary’s Hospital Lacor

Table of Contents Imprint

Experience in Detail Table of Contents ...... 2 “Environmental Sanitation of St Table of Charts ...... 2 Mary’s Hospital Lacor” List of Abbreviations ...... 2 1. General Information ...... 3 Released in

2. Context of the Experience ...... 3 Vienna, July 2014

3. Main Characteristics of the Experience ...... 4 by

4. Stakeholders and Partners – Roles and Responsibilities ...... 5 HORIZONT3000 5. Resources ...... 6 www.horizont3000.at 6. Impact of the Experience/ Practice ...... 6 7. Lessons Learned and Recommendations ...... 7 Edited by

8. Challenges ...... 7 St Mary’s Hospital Lacor 9. Sustainability ...... 8 and HORIZONT3000 10. Experience Sharing/ Up-scaling ...... 8

11. Bibliography ...... 9 With the support of

the Austrian Development Cooperation (ADC) and the Member Organizations of HORIZONT3000

Table of Charts Graphics by

Char 1 Localization of the Experience ...... 3 HORIZONT3000

Contact

Uma Santo Opoka

[email protected] List of Abbreviations

BBM Beschaffungsbetrieb der MIVA (Procurement agency of MIVA Austria)

TBL Technisches Büro Lechner (Consultancy firm for Ecosan Systems) UEDCL Electricity Distribution Company Ltd

1 DKA Austria - Development Cooperation Agency of the Catholic Children's Movement of Austriam, Catholic Men's Movement of Austria – KMBÖ, Catholic Women's Movement of Austria – kfbö, Caritas Austria, Department for mission and development of the Archdiocese of Vienna, Welthaus Diocese Graz-Seckau, Brother and Sister in Need – Diocese of Innsbruck, Brother and Sister in Need - Catholic Action Carinthia

1. General Information day on average 600 inpatients plus their attendants and receives on average 600 The Lacor Hospital (St. Mary's Hospital Lacor) outpatients. There are about 1,000 employees is the largest referral private non-profit catholic combined with their family members living based institution in Uganda whose mission is to within the Hospital. guarantee affordable medical services in particular to the neediest people. It was municipality has 152,276 inhabitants, founded in 1959 by the Comboni while the total population of Gulu district is for the Gulu Catholic Diocese. After 1961 it was 443,733 and that of Amuru district is 190,516 managed and developed by Dr. Piero Corti (an and Nwoya 128,094. Gulu Government Italian pediatrician) and Dr. Lucille Teasdale Hospital, about 6 km from Lacor, has 335 beds Corti (a Canadian surgeon) up until their and is the regional referral hospital. There are deaths: Lucille in 1996 of professionally other small private clinics and drug shops for acquired AIDS and Piero in 2003. commercial purposes in Gulu town and the suburbs. The approach of Lacor Hospital is to complement the government’s efforts in health service provision.

In this document the Hospital wants to present their experience on Environmental Sanitation, which has been made in the period from 2002 to 2005, but the fruits of the experience are ongoing. It is important to share the experience, Char 1 Localization of the Experience because all type of organization needs a reliable water and power supply with good It is owned by the Registered Trustees of Gulu waste management systems. The maintenance Diocese (Archdiocese of Gulu). Lacor Hospital of technical equipment is a must and capacities is registered with the National Board for Non- have to be built to manage available systems. Governmental Organizations and is accredited to Uganda Catholic Medical Bureau (UCMB). 2. Context of the Experience Lacor Hospital activities are in line with Uganda Ministry of Health (Ministry of Health, Republic This experience started during the war and of Uganda) policies of health care provision. covers a period when there was a very difficult The integration of Lacor Hospital into the social and economic environment. Insecurity Uganda national health system has been in line has devastated the economy of northern with national health reform, which was Uganda since 1986 leaving the population in implemented from 1996/1997. The Hospital is dire need, suffering and despair. Even the staff located in Gulu Municipality, about 6 km west of had to live in the Hospital compound with their Gulu town along the Highway to Sudan. It has families in order to be safe. Under the pressure been built on land owned by Gulu Catholic of external events (war and epidemics) the Archdiocese. The Christian doctrine of number of patients in Lacor Hospital was more dedication and providing care to the sick is the than 17.000 admitted patients and 140.000 strong pillar on which Lacor Hospital’s identity outpatients a year. Between 1996 and 2006, and performance rests. Most of the patients between 3,000 to 10,000 “night commuters”, served are among the poorest of the poor, who mostly children and women fleeing the rebel live well below the poverty line. attacks in the surrounding villages, would find refuge every night in the Hospital compound. From a small 30-bed Hospital 55 years ago, This caused an over-utilization of the hospital Lacor Hospital is now a complex with a 482 bed facilities, water, electricity, and management of capacity and 3 Peripheral Health Centers - waste. each with 24 beds (Opit, Amuru and Pabbo), a The waste water treatment in use was a pond Nurse Training School, a Laboratory Training system comprising of 4 lagoons with a total School, Gulu University teaching site for oxygenation surface of 8000 square meters. medical school and other training programmes. The system was put under test during the Ebola Currently, the Hospital accommodates every

Page 3 of 9 epidemic in the hospital due to the exceptionally supply to entire sections of the Hospital high use of bleach (October 2000 – February  Hygienic risks and pollution related to 2001). improper management of waste  Disruption of services due to interruptions in Because of this same epidemic, the safe the power and water supply management of contaminated material and  Frequent damages to Hospital equipments the appropriate disposal of solid waste had due to voltage fluctuations become a problem to be solved immediately  Waste of water and power due to leaks in too. The installation of a new laundry system the distribution systems and to the lack of solved the first problem. As for the solid waste, ways to control consumption a medical waste incinerator was also  High use of non-renewable sources of constructed. But the implementation of a energy (generators) with negative structured waste management system was still environmental impact, mainly due to the a challenge. erratic power supply by the national grid (hydroelectric power) In the power sector, the Hospital had big  High costs of power and water (electricity challenges, because during the frequent and bills, generators and water pumping units) prolonged interruptions of power-supply by the  Lack of properly trained personnel (mainly national grid UEDCL (hydro-power), the electricians and plumbers) in the Hospital hospitals power production relied exclusively on maintenance unit generators. Due to the poor electrical network, which was been built step by step during the All modern health institutions should have a growth of the hospital, there were a lack of good technical infrastructure to international water and power, risks of electrocution and fire, standards. The practice was developed damages to unprotected equipment by the high because of this inevitable need and through fluctuations of voltage of the power supplied by discussions with experts in the field from the national grid, pollution while using the (Austria/) and the Hospita itself. generators, under-utilization of clean sources of power, and eventually increasing and As to gender aspects, the Hospital employs unsustainable costs. mostly female nurses and cleaners, who stand higher risk of infection when there is poor The water supply relied mainly on drilled sanitation. Furthermore, the hospital’s mission boreholes managed by the hospital, since the is to serve the most vulnerable, highest among town water network didn’t have capacity and them are pregnant mothers and children. reliability to supply the hospital, the water was Additionally, the hospital manages all sickness pumped to an old metal tank which was leaking including HIV/AIDS. and insufficient for the growing consumption of the hospital. 3. Main Characteristics of the Technical support services relied on locally Experience assembled technicians (mostly trained on the Volunteer engineers from Italy carried out a first job) under the guidance of a Comboni appraisal of the power distribution system in Brother, since it was difficult to 1998. They identified a high-risk area in the old solicit workforce externally. The technical laundry and immediate corrective actions were department had to do all works and repair all taken. All electrical installations after that date equipment with limited resources. complied with the standards suggested by these experts. Fire extinguishers were also put Summing up, the initial challenges can be listed in place in designated points of the Hospital and as follows: a small fire squad was established.  Electrical and fire hazards due to inadequate distribution system of power At the occasion of the installation of the new  Risk of a major disaster due to lack of an Laundry System funded by Austrian adequate fire-fighting system organizations, an engineer from BBM (BBM)  Hygienic risks due to insufficient water

Page 4 of 9 carried out a preliminary assessment of the technical works also an awareness campaign problems and needs of the water and power on energy saving was done to staff and users of distribution systems in the Hospital. The the sytem. hospital administration also identified the problems at hand seeking for technical The water storage capacity, the rainwater guidance from experts. Planning meetings were collection and the water distribution system held in Uganda and Austria to find a solution in were improved in order to avoid dispersion and the most manageable way. The implementation monitor water usage. Additionally, users’ points of the practice involved experts from Austria, were provided with water saving devices and Italy, and Uganda. staff and general public were educated on water saving. The main objectives of the experience were: Additionally, a water-based fire-fighting system  To increase the protection of people and of was installed and a training conducted including Hospital’s equipment/ infrastructures the already existing fire team. against electrical accidents and fire  To improve the quality of the Hospital’s Finally, a structured solid waste management services, the hygienic standard and the system was implemented with differentiate protection of staffs against professional collection and disposal procedures hazards by providing regular and sufficient (24 hours) power and water supply without After a preliminary survey, there were series of increasing their total consumption, rather by planning meetings in which the mode of eliminating dispersions, wastage and implementation, technical details of the uncontrolled use components to use and general set up of the  To reduce the Hospital’s dependence on systems were discussed. A team of experts in polluting generators the electrical field came from Austria and had  To reduce the hygienic risks and the intensive work at the hospital. During that time ecological impact of unstructured many local technicians were trained on the job management and disposal of solid waste concerning modern technology, ways of work  To increase the Hospital’s capacity of and handling of proper tools. Specified training properly maintaining and managing the was also carried out to selected people who power and water systems excelled in the systems managements. The  To create ecological awareness among systems were handed over with properly Hospital staffs and users designed operations and maintenance guidelines to help in its management. Since To fulfil these objectives, the following then the hospital also evaluates itself its power measures were taken: consumption and water usage annually.

The power distribution system was upgraded 4. Stakeholders and Partners – in order to avoid hazards, dispersion of power Roles and Responsibilities and excessive voltage fluctuations. This involved physical installation works. A power The general beneficiaries are the people distribution house, a generator house and a coming to the hospital to receive health technical workshop have been constructed and services, plus the staff working and residing in trainings for technical staff conducted to ensure the hospital, proper maintenance of the stystem and to establish a technical documentation. Parties, Institutions and Groups of People involved in the implementation of the To ensure 24 hours power supply for experience were: emergency services and adequate light in the  Austrian Development Cooperation: wards without increasing the dependence on Funding agency generators, alternative sources of energy and  DKA Austria: Co-funding agency energy saving devices have been installed and  HORIZONT3000: Monitoring agency consumption monitored. Apart from the physical  BBM MIVA Austria: Project management, execution and coordination

Page 5 of 9  Technisches Büro Lechner (TBL): execution of water aspects New buildings were constructed: the  Lacor Hospital: Local logistics, local labour, electrical distribution room, generator house and beneficiary and technical workshop. With these infrastructures, the hospital increased its The general approach was to combine external efficiency and the security of the electrical and local expertise for carrying out the project systems, and organized shelters for work. and a strong component of training and transferral of know-how was considered. The The Electrical system has been upgraded: execution of the practice involved many areas, the total overhaul of the electrical system with different expertise. involved connecting a new transformer, new  The general project implementation was distributors with protections and voltage overseen by HORIZONT3000 Regional controls, laying of underground cables within Office in . the hospital and installing new UPS system with  Preliminary survey, technical planning, a dedicated generator for critical areas supply. procurement of technical items, All these measures improved the power quality international transports, supervision of the of the hospital: no more power outages in implementation, procurement or preparation critical areas, no machines breakdown due to of documents for environmental power surges, no more fire outbreak sensitisation, and project co-ordination was encountered unlike in the past when there were done by BBM Austria. fires due to bad electrical wiring/system.  The water supply system was planned, managed and executed by TBL including The water system improved substantially: the installation of 7 units of solar hot water. New twin galvanized water tanks of total  Labour for constructions and general works capacity 150,000 litres was constructed was realized by Lacor Hospital utilising its optimizing the water sources of the hospital. A own technical staff and temporary workers. new distribution system, quality materials and  Local logistics and communications, as well water meters provided efficient water supply to as the selection of candidates for training the hospital, manageable and easy to control. and sensitisation actions were organised The lack of water became history. and carried out by Lacor Hospital. Solar hot water systems were installed providing hot water to the maternity ward, 5. Resources operation theatre, nutrition ward and the Besides financial resources, more than 10 laundry. This provided the much needed hot technical experts from Austria in the fields of water for the departments and also saved water and electricity, a Hospital Technical energy which would have been used by Department for professional work and many electricity. casual labourers for a period of 24 months were needed. Safety issues were improved: proper quality systems installed with protective gears meant the hospital was working in a safer 6. Impact of the Experience/ environment, the institution of a fire fighting Practice systems also made it possible for the hospital to The environmental sanitation within the be ready to combat fires. hospital has greatly improved: good and clean water supply, quality and reliable Technical capacity building was realized: the electricity management, experienced technical construction of the technical workshop helped staff, good management of utilities which consolidate and qualify the works of the unarguably has reduced risk of re-infection technical department. The training of around the hospital. The project in general technicians has greatly helped the hospital, raised the standard of service delivery of the especially in the fields of electricity. The hospital. hospital being a team leader in the regions has for many years been assisting neighboring

Page 6 of 9 hospitals and partners of HORIZONT3000 with planning and execution taking account of technical knowhow and support in combating social-cultural differences even within the same problems. idea.

During the execution of the project itself, there The commitment by the various parties were many casual labourers from the involved in the implementation is necessary, neighborhood of the hospital, many local and a strong support from the management of building materials like bricks, sand, gravels etc, the hospital is important to the success of the were bought from the neighborhood of the project. hospital. This helped in raising the economic status of the populace. Additionally, Gender On-site training is a must. For a technical equality and awareness was a good project, all technical people must know what is observation during the project, as women were happening! employed equally with men in the various activities, like trench excavations, cable laying, For all newly introduced technology, they have backfilling etc to take collective decisions. It is not good for the donors to impose a technology on the Furthermore the practice has in-built elements beneficiaries without explanation. This affects of financial sustainability: the sustainability of the job done.  Protection of people from electrical accidents and consequently of the Hospital Follow up phase has to be planned to monitor from financial liability; how partners cope up with this technology  Protection of Hospital assets and equipment from fire and voltage fluctuations; 8. Challenges  No disruption of Hospital activities due to the lack of water and power supply and Main challenges encountered during the project more efficient and therefore economical implementation were: running of its operation;  Delays in transportation of equipment  No leaks of water and power due to power because of the civil war and the road and water saving appliances and fittings; network  Use of solar water heaters and availability of  Delay of the Uganda Electricity Distribution trained staff for preventive maintenance; Company LTD in diverting the high voltage  Monitoring of the consumption of water and line that passed over the construction site power as well as sensitisation on water and and to providea the high voltage meters the power saving Hospital had paid for  Natural conditions, the peak of the Summing up, the effects of the results are: implementation time was when there was  Better service to the patients, of which 80 % much rain. This limited outdoor works and are women and children collection of some local materials.  Reduced professional hazards for the staff,  The technology was higher and needed they live better and work better adaptations for the ordinary technicians  Containment of costs, no wastage  Many spares are not easily available in the  Lower environmental impact, no waste local market. disposed off in the envoironment  There were some disagreements on some  More sense of energy saving brought to the technical details especially in the water staff working in the hospital sector.

Some of the challenges were faced by timely 7. Lessons Learned and procurement of items from abroad to avoid Recommendations extra delays, by engaging the head office of the The Involvement of all stakeholders is electrical company for speedy actions, by paramount. A practice works best when the concentrating on indoor works during rains and beneficiaries are informed and involved in the by the continuous training of technicians.

Page 7 of 9 9. Sustainability 10. Experience Sharing/ Up-scaling For the practice to be institutionally, socially, Success from the Lacor project has been economically and environmentally sustainable, duplicated in smaller scales to other the following elements should be considered: HORIZONT3000 projects. St Francis  The technology utilized, especially for the Naggalama Hospital, Mukono; St Joseph’s electrical systems, is an advanced one. Hospital, Kitgum; and Holy Family Nyapea Although the maintenance team was Hospital, Zombo; among others, have already trained, there is still continuous training of implemented similar practices. the hospital’s technical staff and consultations with the external experts The technical department of Lacor Hospital, whenever possible. especially the service team leader whose  Continuous sensitization of the hospital capacity was built during the project is often employees and users of the systems is consulted and assists in solving technical going on. Good practices for saving water, problems in other institutions. electricity and waste handling should be a routine. Continuous upgrade with advancement in  Operations and Maintenance charts should technology is always in process. Now over ten be followed regularly and monitored. years after the project completion, a general  Policies for avoiding wastage by the review is being made and some components hospital employees should be considered, require change. As a recommendation, we like fees for excess electricity use. should take into account to use more renewable  Establishing links with suppliers for energy source especially solar energy which is procurement of genuine spares is a abundant these days. continuous activity.  The Hospital itself should provide funds for Described experience could serve as a the operation and maintenance of the reference for most of the hospitals in the region installed systems. with the same setting, such as Kalongo  Continuous awareness campaign to the Hospital, Aber Hospital, Angal Hospital and hospital staff and the general patients and Lwala Hospital. Generally all major hospitals attendants who visits the hospital are and big institutions require such systems. necessary to avoid wastages and losses.  Other sources of renewable energy should be explored, notably the photovoltaic solar systems.

Page 8 of 9 11. Bibliography Archdiocese of Gulu. (n.d.). Retrieved October 2015, from http://www.archdioceseofgulu.org/

BBM. (n.d.). Beschaffungsbetrieb Miva. Retrieved October 2015, from http://bbm.miva.at/en/

Ministry of Health, Republic of Uganda. (n.d.). Retrieved October 2015, from http://www.health.go.ug/

St. Mary's Hospital Lacor. (n.d.). Retrieved October 2015, from http://www.lacorhospital.org/

TBL. (n.d.). Technisches Büro Lechner. Retrieved October 2015, from http://www.oberwindhag.at/tbl.html

UCMB. (n.d.). Uganda Catholic Medical Bureau. Retrieved October 2015, from http://www.ucmb.co.ug/

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