COMMUNITY DIRECTED INITIATIVES IN DISEASE PREVENTION AND CONTROL The True Spirit of Alma Ata Declaration on Primary Health Care InsightInsight 12345678901234567890123456789012123456789012345678901234567890121234567890123456789012345678901212345678901234567890123456789012123456 12345678901234567890123456789012123456789012345678901234567890121234567890123456789012345678901212345678901234567890123456789012123456 12345678901234567890123456789012123456789012345678901234567890121234567890123456789012345678901212345678901234567890123456789012123456 12345678901234567890123456789012123456789012345678901234567890121234567890123456789012345678901212345678901234567890123456789012123456 1234567890123456789012345678901212345678901234567890123456789012123456789012345678901234567890121234567890123456789012345678901Oct-Dec042123456 Kanungu “Chief” Speaks about Onchocerciasis Peace Habomugisha∗ From a variegated background (social, political, geographical, temporal and much more), the reader is led to some keywords, the interview itself and, lastly, to the core of the main speaker’s remarks. Setting and Time gram goals to his subjects. When he is in Kampala, to cite one Elias Byamungu is the Chief Ad- more, he makes it a point, again ministrative Officer (CAO) of and again, to call at the national Kanungu District in the southwest offices of The Carter Center of Uganda. The writer was sched- Global 2000 to know the latest uled to interview him on April 29, developments, in our plans and 2004 – the occasion of a regional work, that may interest and ben- efit the people of Kanungu. The idea of limelighting him, did, in- deed, arise when we realized In this Issue: that he was a great driving force Kanungu Chief Speaks Kanungu “Chief” Mr. Elias Byamungu, speaks out in CDTI implementation in his about Onchocerciasis area. The fact that he is the ulti- .............................Pgs. 1 - 5 mate controller of his district’s finances, did, also, make him a review, in Kanungu town, of the topic of much attraction and at- A Decade and more of treatment and control of onchocer- tention for our data collection Onchocerciasis Control ciasis. The interview never took and dissemination. with Mectizan place as he had other more pressing ............................ Pgs. 6 -10 commitments that day. Weeks later, on 19 May 2004, this reporter did, Key Terms Treatment Updates however, succeed in arranging an- .................................. Pgs. 11 Qn. is an abbreviation of ques- other audience with him. Kampala, tion while the acronym ans. this time, was the venue of the ques- means answer. As a matter of News Flash tion-and-answer session between .................................. Pgs. 11 course, the reporter asks the the “chief” and the interviewer. Be- questions to which the inter- low, a shortened edition, of record- viewee responds. Clar stands for ings of the meeting, comes to the clarifications made by reader. Why, you will likely ask, was Habomugisha – each of which Publishedby:Global2000 he made the focus of this important RiverBlindnessProgram provoked from Byamungu a re- RiverBlindnessProgram interview? Everywhere in his con- andVectorControlDivision, sponse identified as bym for MinistryofHealth, stituency, Byamungu has been a convenience sake. The former’s Plot15BomboRoad powerful backer of policies and pro- clarifications, on the whole, Typesetby:Global2000, grams of community-directed treat- have to do with issues of sup- RiverBlindnessProgram; ment with ivermectin (CDTI). Thus, port from APOC. Clarifications P.O.Box12027,Kampala for one example, he has crisscrossed aimed to bring Byamungu face Tel:256-41-251025 his district, in the company of our Fax:256-41-349139 Fax:256-41-349139 DOC for the domain, to sell our pro- This newsletter is supported by The Carter Center, and Ministry of Health - Uganda to face with certain issues, to able but boil it. I also mobilized or more. A tablet of the drug costs which there was no direct atten- people to pressurize government to about $3 at factory price. This is tion from him, in questions asked provide certain amenities through not sustainable for our econo- him minutes earlier. development projects, etc. mies, especially among poverty- stricken communities. In effect, Qn.: How did you know about on- preventive measures, like those The Interview chocerciasis? of Primary Health Care (PHC), Qn.: Can you, please, give us a are the best way to contain the brief history of your work experi- Ans.: When I worked in Fort Portal disease. I understand the drug is ence? there was a Basic Health Services also a good de-wormer and that Project run by the German Techni- is why we need to keep an eye Ans.: I have been in Uganda’s cal Cooperation agency (GTZ); and on it in the stores. If no such se- civil service for 18 years so far, this was in 1988. It had a compo- curity was provided and if the working in various capacities and nent of onchocerciasis control. That proper instructions of using it in districts like Bundibugyo, Fort is where I learnt about river blind- were not adhered to, children and Portal and Ntungamo. I worked in ness, ivermectin, the effectiveness others not supposed to take the the Ministry of Local Govern- of the drug, etc. We were able to drug would access it. ment: There I gained experience eradicate onchocerciasis in the for- as a national trainer for decentrali- ests of Mwenge and the valleys of Qn.: After knowing that much zation and this took me to all parts Bundibugyo. about onchocerciasis how did it of the country. I became a deputy impact on you? CAO in 2000 when I was posted Qn.: What do you know about on- to Ntungamo. I became a CAO in chocerciasis? Ans.: There was an old man in June of 2002 and started working my village, when I was growing in Kanungu in July of the same Ans.: It occurs in places that have up, who had an ailment resem- year. specific physical features such as bling elephantiasis. Once I learnt deep valleys, which are long and about onchocerciasis, I decided Qn.: What have been your major with fast flowing waters and bushes to send him ivermectin. He was challenges and strengths during with canopies. In there is the home very excited and I was happy that the course of your work? of the blackfly, which is responsible I could create such change in for causing river blindness. If it were him. Anything to do with blind- Ans.: My greatest challenge has possible each district should have a ness, talking generally, makes me been to open up closed places, functional vector control unit, part scared stiff. After knowing about which have not had a serious dos- of whose work would be to gather onchocerciasis and the problems age of public investment, e.g. in these flies and determine how and it can cause people, I have had to Bundibugyo. There, there were no when the health ministry and local be personally involved in activi- proper roads and no good houses. government can and should inter- ties for curbing the disease. Al- By the time I left, however, many vene. I was taught that when the fly most always, indeed, I push good houses had been built; a bites people, it takes some time be- Kanungu’s District Onchocercia- good road had been constructed; fore symptoms of the infliction, sis Coordinator to carry out well and one can now take only 6 hrs such as hardening of skin and its his duties. from Fort Portal to Bundibugyo as peeling off as if it has been burnt, opposed to the original 12-hour appear. Some cases of it are similar Qn.: What, however, are some of journey. to elephantiasis – the feet become the specific roles that are played so huge. Taking the ivermectin drug, by you and your district in the My strength is to simplify myself. early, can reduce these problems. It combat of onchocerciasis? If there is no electricity, I work takes a long time to treat this without it; no flowing water, I malady: one needs to swallow the Ans.: Social mobilization is one. manage with the little that is avail- drug once a year for about 10 years I call all LC1s twice a year to 2 brief them about our achieve- ments and challenges in the struggle. As a matter of account- ability, I give them figures of how much was disbursed to their vil- lages. This also influences them to demand accountability from their sub-county authorities. Without fail, I ask people, in Kanungu’s affected areas, to con- firm that they receive ivermectin, to discourage users of the drug from opting out of the treatment and control scheme, and to always let me know if they are benefiting from the medical service. Looking on is the CAO at a workshop The district’s responsibility is to ensure that financial and other re- Qn.: What have been the benefits and other people to talk about sources are mobilized in order to of the onchocerciasis program in problems of onchocerciasis. contribute to the onchocerciasis Kanungu? More attention would surely be program: Each sub-county makes paid by the public because such a token contribution. We still have Ans.: They are immense! I cannot voices as mine are familiar to a problem with the LC3s, though, compute them in monetary figures. them. Different people, with because they do not prioritize on- The disease has declined tremen- great authority, would indeed chocerciasis in their plan. dously. No new cases are coming make a difference through such up. Although we cannot measure air programs. Qn.: What have you found fasci- them accurately, we can say, “We nating about your involvement in have almost eliminated this prob- Another weakness is that on- those activities? lem.” chocerciasis control is not yet fully integrated in the overall dis- Ans.: Every time I call at a sub- Qn.: What holes exist in the pro- trict development plan. It needs county’s head offices, I learn gram? to be regarded and treated as a something new. For instance I re- district activity and not a Global cently discovered that some sub- Ans.: Our communication strategy 2000 activity. Purchases of drugs county officials are extracting tax is not without flaws. We produce by the District Medical Officer from sick individuals, including bulletins but as you know some (DMO), for instance, should in- casualties of onchocerciasis.