Alison Cowan, a GP from the UK, and her family have recently returned after a fabulous 18 months in Uganda working with the IMG group through the charity VSO. She came to Uganda initially to facilitate the training of medical staff across the various IMG primary care clinics. Through this work she came to appreciate the enormous burden of sexually transmitted disease (STD) and its devastating consequences within Uganda and especially Kampala and recognised the need for a comprehensive sexual and reproductive healthcare service. So, once her original placement objective was fulfilled, she extended her placement to work with the Touch Namuwongo Team based at the International Hospital of Kampala (IHK), within the neighbouring communities, to tackle this growing problem of STDs.

Even though STDs are very prevalent in Kampala, and are responsible for a lot of death and disease, very little attention and minimal resources are focused on this area, beyond HIV. The Touch Namuwongo team work with the poorest members of the Kampala community local to IHK and offer services for HIV, TB and STDs. With respect to STDs, prior to Alison’s involvement, the team were just able to treat the symptomatic cases in their hospital clinics and community outreach. However, this approach was only scratching the surface of the problem as 50-70% of disease can be silent. There was no system or resources in place to identify and screen those members of the community most at risk from these diseases and who were often without symptoms. As well as unknowingly transmitting these diseases on to others, the presence of STDs also facilitates transmission of HIV so further fuelling the HIV epidemic. Alison developed a risk score tool capable of identifying such members of the community and which would also then appropriately target their limited resources to the most in need of treatment. Despite resources being very stretched, with the enthusiasm and commitment of the Touch Namuwongo team, the support of IMG and the help of kind donations they were able to get establish a comprehensive service which identified both symptomatic and asymptomatic disease.

Alison also obtained some funding from Oxford University to carry out a research project that aimed to derive and validate this risk score tool. As an associated benefit, the study also funded a large volume of screening and medicines for treatment of STDs in the data gathering process.

The Touch Namuwongo team took on the extra burden of work involved in the study without complaint and worked tirelessly to deliver the service and also produce the data which is in the process of being analysed to develop an effective protocol going forward.

Initially Alison was heavily involved in the actual running of the clinics, but by the time Alison returned to the UK, the team was delivering the service without any additional input and continues to do so with great effect, despite the challenges and hard work this entails. Even though the clinics are already very busy, the team recognise what a valuable service it provides and so continue to reach out to the community to encourage others to be screened and treated, especially those communities where the need is greatest. They have got a good relationship with the local commercial sex workers, who continue to attend the clinics and who themselves are becoming advocates of the service.

The research funding has now drawn to an end and so there is a desperate need for on-going funding to continue to deliver this valuable service. Alison continues to raise funds for the STD programme through Suubi Trust, recently speaking at a local church lunch and is soon hosting a Ugandan party for supportive friends in her native St Albans.