DASHA MEDICAL CAMP
8TH – 10TH MARCH, 2018
ACTIVITY REPORT
Collaborating Institutions Dasha Support Group Limited
The AIDS Support Organization, Mbale Branch
Program for Accessible health Communication & Education, Eastern Region
Bukwo General Hospital
Bukwo District Local Government
USAID Regional Health Integration to Enhance Services in Eastern Region
Bukwo District Office of the Woman Member of Parliament
Financial Support This Medical Camp was made possible through Voluntary Member Contributions with support from collaborating institutions.
Disclaimer The observations and conclusions in this report are those of the authors and do not necessarily represent the official position of any of the collaborating institutions.
Suggested Citation None
Access This Report Online Dasha Support Group Ltd: http://dashagroup.org
Contact Information Dasha Support Group Ltd
Bukasa Road, Namuwongo
P. O. Box, 35903
Kampala – Uganda
Tel: +256 772351996/ 752025084
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E-mail: [email protected]
Website URL: http://dashagroup.org
Contents Collaborating Institutions ...... ii Financial Support ...... ii Disclaimer...... ii Suggested Citation ...... ii Access This Report Online ...... ii Contact Information ...... ii List of Abbreviations ...... iv List of Tables and Figures ...... vii Foreword ...... vii 1.0. Executive Summary ...... 1 2.0. Introduction ...... 1 3.0. Objectives...... 2 4.0. Planning...... 2 5.0. Mobilization ...... 2 6.0. Implementation ...... 2 Figure 1: Service locations, Responsible institutions, and Range of services ...... 3 7.0. Achievements ...... 4 Figure 2: Service Uptake ...... 4 Figure 3: Gender-Based Violence Reports ...... 5 8.0. Challenges ...... 5 9.0. Lessons Learnt ...... 6 10.0. Conclusion ...... 6 11.0. Appendices ...... 8 Appendix 1a: Local Government Approval ...... 8 Appendix 1b: UMDPC Approval ...... 9 Appendix 2: Photo/Video Consent – English ...... 10 Appendix 3a: Medical Form-5 ...... 11 Appendix 3b: Referral Form ...... 12 Appendix 4: Photographic Highlights ...... 13
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List of Abbreviations
AIDS Acquired Immune Deficiency Syndrome
APL Annual Practicing License
ART Anti-retroviral Therapy
BNF British National Formulary
CaCx Cancer of the Cervix
CCF Congestive Cardiac Failure
CD4 CD4 T-lymphocyte cell
CNS Central Nervous System
CVS Cardio-vascular System
DM Diabetes Mellitus
ED Erectile Dysfunction
EID Early Infant Diagnosis
EMTCT Elimination of Mother-To-Child Transmission
FBS Fasting Blood Sugar
GBV Gender-Based Violence
GERD Gastro-oesophageal Reflux Disease
GIT Gastro-intestinal System
GUT Genito-urinary System
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Hb Blood Haemoglobin
HBsAg Hepatitis B Surface Antigen
HBV Hepatitis B Virus
HCT HIV Counselling and Testing
HIV Human Immune Virus
HTN Hypertension
HTS HIV Testing Services
IHD Ischaemic Heart Disease
IUD Intra-Uterine Device
JMS Joint Medical Stores
LC Local Council
MF-5 Medical Form – 5
MoH Ministry of Health
MSS Musculo-skeletal System
OPD Out-Patient Department
OVC Orphans and Vulnerable Children
PACE Program for Accessible Health Education & Communication
PID Pelvic Inflammatory Disease
PTB Pulmonary Tuberculosis
PTID Patient Identification Number
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RBS Random Blood Sugar
RDT Rapid Diagnostic Test
RHITES-E Regional Health Integration to Enhance Services in Eastern Region RPR Rapid Plasma Reagin
SAM Severe Acute Malnutrition
SRRH Soroti Regional Referral Hospital
SCD Sickle Cell Disease
SOP Standard Operating Procedure
SRH Sexual and Reproductive Health
STI Sexually Transmitted Infection
TASO The AIDS Support Organization
TB Tuberculosis
UBTS Uganda Blood Transfusion Services
UCG Uganda Clinical Guidelines
UMDPC Uganda Medical and Dental Practitioners’ Council
VHCT Voluntary HIV Counselling & Testing
VIA Visual Inspection with Acetic Acid
VLS Viral Load Suppression
VMMC Voluntary Male Medical Circumcision
WHO World Health Organization
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ZN Ziehl-Neelsen Stain
List of Tables and Figures Figure 1: Patient Flow
Figure 2: Service Uptake
Fig 3a: Sex characteristics
Figure 3b: Patient Presentations
Table 1: Service Performance
Table 2: HIV Prevention Services
Table 3a: Family Planning Services
Table 3b: Cervical Cancer Screening
Table 4a: Donor characteristics
Table4b: Referrals
Foreword Once again, with pleasure, we present to you a written evaluation of our second Medical Camp held in Bukwo, one of the hard-to-reach districts of Uganda, located north-east of Mbale town, along the eastern slopes of Mt. Elgon, close to the border with Kenya.
Upon the invitation of the Woman Member of Parliament of Bukwo district, Hon. Evelyn Chemutai, we set out to conduct a 3-day Medical Camp starting Thursday 8th to Saturday 10th March, 2018. The Camp was intended to be part of the activities held by the district to commemorate the 2018 International Women’s Day Celebrations and it was to be coordinated by Dasha Support Group, in liaison with The AIDS Support Organization (TASO), Program for Accessible health Communication & Education (PACE), Bukwo General Hospital, Bukwo District Local Government, and USAID RHITES-E. Other areas of intervention included recognition and award of academic and sports talent, as well as promoting positive behavior change through spiritual mentorship and prayer.
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Between Thursday 8th and Saturday 10th March, at least 943 people received free health services including: general medical care in an Out-Patient Department – like setting (OPD), HIV Counselling & Testing (HCT) plus screening for Tuberculosis (TB) and Cervical Cancer (CaCx), Family Planning services, and support for survivors of Gender-Based Violence (GBV). At the centre of service delivery were staff of Bukwo General Hospital and members of the District Health Team (DHT) led by the District Health Officer, himself, Dr Satya Collins.
This report highlights the achievements, challenges and lessons learnt through the implementation of this activity.
We wish to acknowledge our partners and collaborators, without whom this Camp would never have been possible: 1. TASO, Mbale Branch 2. PACE, Eastern Region 3. Bukwo General Hospital 4. Office of the Woman Member of Parliament, Bukwo District 5. Office of the District Health Officer, Bukwo 6. Bukwo District Local Government 7. USAID RHITES - E In a very special way, we recognize all our Medical and Non-Medical Volunteers who unreservedly give of their time, money and effort towards the furtherance of our organization’s objectives.
Last but not least, we thank the community of Bukwo District together with the local leadership for welcoming us and giving relevance to the work we do; it is always an honour and privilege to serve humanity.
Thank you!
Dr Dorothy Aibo
MB ChB (MUK), Dip. PPM (UMI), MPH (UoM)
Executive Director, Dasha Support Group Ltd
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1.0. Executive Summary Bukwo is a district located on the eastern slopes of Mt Elgon, adjacent to the border with Kenya. It has a difficult terrain and poor access roads, making it a hard-to-reach area in Uganda. With a catchment population of approximately 74,000 people, Bukwo district has got only three (3) doctors namely: the District Health Officer, the Medical Superintendent of Bukwo General Hospital, and one other Medical Officer, serving a clientele of over 4,000 patients. Patients in need of specialized services are often referred to Mbale Regional Referral Hospital. However, owing to the difficult terrain and bad roads, critically ill patients sometimes die in transit whilst those not critically ill may resort to alternative medicine.
Against this background, Dasha Support Group, in collaboration with TASO and PACE, set out to conduct a 3-day Medical Camp in the district, delivering a wide range of health services, including general medical care, HIV Counselling & Testing, Screening for TB and Cervical Cancer, and various Family Planning methods. The Camp was welcomed by both the community and district leadership, receiving Local Government Authorization and Uganda Medical and Dental Practitioners’ Council (UMDPC) Approval. USAID RHITES – E supported the District Health Team to provide screening and linkage support to survivors of Gender-Based Violence alongside other health and social services. Overall, at least 934 people received free services onsite whilst 10 patients got referred to Mbale Regional Referral Hospital for more specialized care.
Personnel, procedures, equipment & supplies met standard requirements set by UMDPC in the CAMPS Application Form.
Achievements, challenges and lessons learnt from this Camp are all detailed in subsequent sections of this report which will be filed with the UMDPC office and made accessible to stakeholders and the general public through our website URL: http://dashagroup.org/category/publications
2.0. Introduction The reason for our existence is to increase access to basic health services amongst vulnerable groups of individuals, as well as underserved communities, thus reducing morbidity and mortality from preventable causes. We achieve this by leveraging Public-Private Partnerships in line with Health Sector Development Plan strategies. Our goal is to strengthen already existing government structures and promote sustainability.
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3.0. Objectives The objectives of the Camp were:
1. To provide out-patient medical services 2. To provide HIV Counselling and Testing Services 3. To screen women of reproductive age for Cervical Cancer 4. To provide various methods of birth control to women of reproductive age 5. To refer patients for specialized care at Mbale Regional Referral Hospital 6. To demonstrate the love of Jesus and minister spiritual alongside physical healing
4.0. Planning Preparations commenced upon confirmation of the dates for the event by the Honourable Woman Member of Parliament for Bukwo District. We began by gathering all the necessary documentation to support our application to UMDPC. This involved mobilizing a team of volunteer health workers who had to provide us with current copies of their Annual Practicing Licenses (APLs). We then reached out to the district leadership through the Office of the DHO to obtain Local Government Authorization to accompany out application to UMDPC. Finally, we made contact with the management of Bukwo General Hospital through the Office of the Medical Superintendent, and then informed the Police through the Office of the District Police Commander (DPC) whom we kept in copy of further correspondence regarding this event. A couple of Planning Meetings happened between Hon. Chemutai and our leadership ahead of the event. We also reached out to the leadership at TASO and PACE to secure their time and participation at this event.
5.0. Mobilization Mobilization happened at various levels to secure human, financial and material resources. This involved reaching out to various individuals and institutions for various forms of support, ranging from financial and in-kind contributions, to physical participation. Community participation was secured through social mobilization with the help of the local community leaders at various gatherings including places of worship, Local Council meetings, funerals, etc. Although necessary, we did not manage to secure any radio announcements or talk shows for this event.
6.0. Implementation Prior to the event, we held planning meetings but did not make efforts to have representatives from the district leadership. The District leadership, on the other
2 hand, with support from USAID RHITES-E, had planned to provide additional services not included in our scope such as immunization against HPV for young girls aged 10 years and below, screening and linkage support for survivors of GBV, general health education, and nutritional assessment. Thus, we held a meeting to harmonize our ideas and plans, as well as agree on the set up of the venue since the location had changed from Bukwo General Hospital to Amanang Primary School. Responsibility was assigned to the three major institutions (DASHA, TASO and PACE), each working closely with members of the DHT.
By 0900 hours, crowds had already started gathering. On arrival, therefore, we set the place up, made a few remarks which included translation of our Photo/Video Consent Statement, and started issuing Patient Identification Numbers (PIN) corresponding to patients’ order of arrival. Triage and Registration activities were closely intertwined, thus, patients requiring emergency care or special consideration were quickly identified and isolated from the queues. These were managed differently, on a case by case basis; they included critically ill patients, pregnant women, nursing mothers and the elderly.
PINs were attached to sticky notes of varying colours depending on the category of service required. Patients then got ushered into a Waiting Area after registration from where they were later directed to the respective health service provider. In the Waiting Area, health education and nutritional assessments were conducted.
Patients not served by close of business the first two days were asked to return the following day and did not have to queue again provided that they presented the PINs given to them the previous day on coloured sticky notes on arrival.
Given the high turn up, registration of new patients was closed on Friday 9th to enable the Medical Team to review all patients registered the previous two days; this was meant to ensure that no patient returned home unattended at the end of the three days.
Figure 1: Service locations, Responsible institutions, and Range of services
Service Responsibility Activity Station Reception DASHA Triage TASO Registration and PIN allocation DHT Waiting Area DHT Health Education Nutritional Assessment DASHA DASHA General OPD Services & Treatment Territory DHT
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of Common Illnesses TASO TASO HIV Counselling & Testing Territory DHT TB Screening PACE PACE Cervical Cancer Screening Territory DHT Family Planning Methods HPV Vaccination Gender-Based Violence Support
7.0. Achievements
Figure 2: Service Uptake Service Uptake
OPD HCTS TB CaCx FP GBV
Of 943 community members that sought services at the Camp, we reviewed and treated 439 patients (46.6%) for common illnesses including but not limited to Urinary Tract Infections (UTI), Sexually Transmitted Infections (STIs), Gastro- Eosophageal Reflux Disease (GERD), Peptic Ulcer Disease (PUD), Arthritis and Neuropathy. Ten of these needed specialized care and were referred to Mbale Regional Referral Hospital.
Having counselled and tested 260 individuals (27.6%) for HIV, two tests turned positive. Of the two positive results, one was a new diagnosis – a young teenage girl thought to have been orphaned by HIV. She had been brought to the Camp by a care taker who reported that she had been sickly. The other positive result belonged to a
4 known positive male patient not yet initiated on HAART. The two were linked to care at the nearest HIV Care Centre.
Seventeen (17) patients further presented with symptoms suggestive of TB. These were screened and those able to produce sputum had their samples analysed. Of all the samples analysed, we registered no sputum smear positive result.
Seventy eight (78) women of reproductive age sought to be screened for Cervical Cancer by Visual Inspection with Acetic Acid (VIA), constituting 8.3% of the registered attendance. All were normal except one who exhibited suspicious lesions. She was counselled and immediately referred to Mbale Regional Referral Hospital for further investigation and management.
A service related to Cervical Cancer screening was birth control or Family Planning. At least 61 women of reproductive age (6.5%) sought to get started on modern birth control methods including implants (30), IUD (23), Injectaplan (3) and the Pill (5). A small number of recipients is not accounted for due to incomplete records.
Finally, 88 women (9.3%) reported to have been assaulted by their spouses in the recent past. These were counselled and linked to a support group. Results from the standard screening tool are summarized below.
Figure 3: Gender-Based Violence Reports Type of violence Number Reporting Psychological 54 Physical 13 Physical & Psychological 08 Sexual 07 None 06
8.0. Challenges Among several challenges associated with organizing such an activity are financial, material and human resource constraints.
It took a lot of time and effort to mobilize health personnel. Some willing volunteers did not have current Practicing Licenses and got disqualified. Other health care volunteers that committed to the Camp earlier got last minute engagements and withdrew their participation. A key constraint was the lack of facilitation in form of volunteer allowances. Important to note is that only a hand-full of people are willing to commit to this kind of work without a financial incentive
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Drugs, sundries and equipment are the most costly item on our budget and couldn’t be secured earlier due to financial constraints. Even then, the money available could only procure a limited variety and quantity of drugs. Sadly, Paediatric formulations had to be eliminated from the list owing to their high cost. Pharmacies and drug companies approached for donations gave only three drugs, two of which are not useful for treatment of common illnesses – these included steroids and anti-psychotics. Others offered items close to expiration Owing to Bukwo district’s remote location and bad terrain, the journey to the Camp venue turned out to be a nightmare and cost us more than we ever anticipated. Stranded with only two borrowed Toyota Harriers for the team, we took the risk and before we could reach, one of our vehicles broke down. The cost of fixing these vehicles could have financed a similar Camp in Kampala. Travelling to Bukwo requires Land Cruisers or other vehicles designed for use on mountainous and difficult terrain
9.0. Lessons Learnt For future Camps, we will need to hold at least two Planning Meetings involving the district leadership so as to harmonize plans and manage expectations Pre-camp assessment trips will need to be considered for future Camps to determine feasibility and cost We’ll need to “prequalify” some potential medical volunteers and have their current Practicing Licenses on file in anticipation of a Camp. Further, it will be prudent to include a budget for the volunteers’ facilitation as an incentive Given our financial limitations, we could consider reaching out to underserved communities within the central district of Kampala; areas such as slums would greatly benefit from our services and the cost could be much less Medical Camps should be restricted to one or two days at most, preferably during the weekend such that willing volunteers are not torn between their jobs and their volunteering commitments
10.0. Conclusion The need for health services in Bukwo district cannot be overemphasized. There are already some existing government structures in place that can be strengthened to increase access and utilization of services. More efforts should be directed towards supporting the district leadership to deliver quality services to the people.
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Improving accessibility by tarmacking the main road to the district would attract more development partners and thus improve service delivery in the district.
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11.0. Appendices
Appendix 1a: Local Government Approval
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Appendix 1b: UMDPC Approval
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Appendix 2: Photo/Video Consent – English
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Appendix 3a: Medical Form-5
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Appendix 3b: Referral Form
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Appendix 4: Photographic Highlights
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