The Challenge of Sustainable Health Care in Bwindi

How do poor people living in rural Africa afford the quality of health care that they need?

• They cannot rely on Government. By the time cash trickles down from the capital city much of it has been ‘lost’. Bwindi Community Hospital receives less than 1% of its funding from Government.
• They cannot afford a fee for service. User fees force payment upon those who are least able to afford to pay hospital bills, leading to catastrophic health expenditure when people have to sell assets, such as land or animals, to pay for treatment.
• They cannot rely on donors forever, as support will eventually dry up leaving the community with no health care.

eQuality Health – the solution

International Medical Foundation is working with Bwindi Community Hospital to design, implement and manage a sustainable solution to the funding of health services in Bwindi (SW Uganda). We are starting a Health Scheme called eQuality Health Bwindi.

All members of the Bwindi community have the chance to ‘subscribe’ to this scheme by making a single annual payment of UGX 6000 (£2) per person which entitles them to use Hospital Outpatient and Inpatient services including investigations, drugs and even operations at a cost of only UGX 1000 (30p) per visit. This scheme enables people to pay for health care collectively and in advance, instead of waiting until they become sick and fearing the cost of care. It protects the poor, and enables them to have some control over their health care. It also maintains high quality services for the people of the Bwindi area for the future.

eQuality Health Bwindi already has 30,000 community members who have shown an interest in the Scheme. This is a very poor region and our initial research has indicated that each member can only afford £2. Bwindi Community Hospital has estimated that the cost of care will be at least £4 and so we need to work together with sponsors and supporters of Suubi Trust to help meet the difference.

Please read the Case for Support to learn more…

Bataka Twetambire
“let us heal ourselves”

This year IMF has agreed to work with Bwindi Community Hospital to launch a new community based healthcare scheme, eQuality Health Bwindi.

We are very impressed by the great work being done at BCH by Dr. Paul Williams and his team. We also note the exceptional levels of transparency and accountability that they give to their partners and supporters. The following video is a recent update for Eurochange Charity which has been supporting CHAP (Child Health Access Programme); an initiative providing free quality healthcare to all of the local children under 5 years of age.

CHAP is a forerunner of what we are hoping to achieve with eQuality Health; we will post more about this in the days to come. In the meantime you can read more by visiting http://www.bwindihospital.com/e-Quality%20Health.html

Amina came to us eight months after her accident; she had spent 5 of those months in a plaster without much improvement and little hope. Amina spent only five days on Hope Ward, had surgery and within less than a week after she was discharged she could bear weight and had improved remarkably!

Hope Ward is the charity ward at International Hospital Kampala (IHK).  It was first opened in April 2006.  Almost four years later the ward has a 17 bed capacity and hosts a Cancer Treatment unit. Half the ward is set aside for children and the other half is divided into Male and Female sections with one isolation room.

IHK provides the Ward space, facilities and utilities for Hope Ward free of charge and in addition subsidises all Hope Ward bills by at least 30%, thus charging only marginal cost on all Hope Ward patient treatments.

The Overall Aim of Hope Ward is to:

Cater for the underprivileged in need of high quality complex treatment, who would otherwise not afford this much needed and often life saving care. We intend to do what we can to alleviate the suffering and improve the quantity and quality of life of our patients.

In 2009 there were 248 admissions on Hope Ward with a total of 2,437 bed nights; 93 were children no older than 10 yrs and of the adult admissions 79% were women.

The total amount spent on patient treatments, Hope Ward staff salaries, specialist fees, as well as transport and other assistance given to very needy patients was UGX 499m (£160,000). Hope Ward sponsorships covered 36% of these costs, the rest (£100,000) was paid by International Hospital Kampala.

Please help if you can by donating online, click the Justgiving image below.

• Abused by his grandmother at age 12, locked in a metal box,
• Rescued by his neighbours,
• Thought to be dying, handed over to a hospice,
• Brought by the hospice nurse to Hope Ward, unable to move, talk or look after himself,
• After very many months of loving care and treatment now looking for a new home and a new start.

You can read his story below or by clicking here.

If you would like to help Mubiru and our other patients on Hope Ward click here to find the many different ways in which you can give. Please tell others.

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Mubiru Lwasa is a young 12 year old boy who has suffered a great deal. Mubiru has never really had a place to call home. His mother and father are separated and have moved on to marry other partners and have other children. He lived with his mother for several years and she took him to primary school however he fell sick and she took him back to his father. At this point she had five children with her current husband (not Mubiru’s father) and she could not continue to care for him. This would mark the beginning of a long period of suffering and abuse in Mubiru’s life.

Mubiru was taken out of school and did hard labour for his grandmother and at some point was beaten so badly that his hand and leg were fractured. He was locked up in a metallic box and starved almost to the point of death. When Mubiru’s father noticed that his son was dying, he took him back to his village in Mpigi for fear of the cost of transporting a dead body.

When Mubiru’s father arrived in Mpigi the people in his village were shocked by the site of the boy’s emaciated body. The villagers refused to let Mubiru’s father rest until he had taken him to hospital. On arrival at Mulago hospital the nurses and others who saw Mubiru’s father carry his crippled smelly body into the hospital were so outraged they wanted to lynch him. Mubiru’s father was then ‘rescued’ by the police and taken to Luzira prison.

However now that Mubiru’s father was taken away there was no one left to take care of Mubiru while he was at Mulago. Fortunately a kind Ugandan lady (Mable) had compassion on him and chose to look after him, though she did not really have much to offer him but loving care.

Medical personnel at Mulago thought Mubiru was dying and contacted a nurse who works for Hospice Uganda. This lady contacted Hope Ward and asked us to admit him for treatment as she did not think he was terminally ill.

When Mubiru first arrived at Hope Ward, he was in very bad shape. He had sores and wounds all over his body. He could barely support himself in the wheelchair and the slightest movement would make him scream. Mubiru could neither talk nor feed himself, he was incontinent, he was very pale and the hair on his head was so thin, his lips were pale dry and chapped, he looked like a patient with full blown AIDS.

In September 2009:

Mubiru had been on the Hope Ward for about two months. With an improved diet, constant care and daily physiotherapy as well as constant dressing of his wounds, Mubiru’s condition had greatly improved. At this point he was still feeding through a nasal tube most of the time, though he had started a little self feeding. He regained ability to talk and even sang a song to one of our visitors on Hope Ward at the time. Mubiru is a charming naughty boy and all on Hope Ward became very fond of him. One nice cool evening he even requested his carer Mabel to take him out on the wheel chair to enjoy some fresh air in the hospital compound. The physiotherapist noticed that he tried to move his arms and legs (though he would cry while doing so) during his physio sessions.

By November 2009:

Almost all Mubiru’s wounds had healed, his hair had grown back, he was finally fit enough to start a series of surgeries to treat infections in his bones and to straighten his contracted legs. However at this time Mubiru was incontinent and had been wearing diapers since he came to Hope Ward…he had lost ability to control his bladder and bowels because of his long period of abuse.

At this time, Mubiru had gained more strength and began to talk more, much of his memory had returned and he began to give more details of what happened to him before he was brought to Hope Ward. His father had a final court case in the same month (November); Mubiru gave his police statement for the case and we were hopeful that justice would be served but he was only accused of neglect and given an eight month sentence.

We witnessed a very emotional moment on Hope Ward when we called Mubiru’s mother and had him talk to her, he cried really hard and yet she did not commit to come visit him, she was afraid that she would be arrested. Mubiru’s mother has several children from different men, she had left Mubiru with her mother who died shortly after and Mubiru was taken to be with his father where he was abused and almost killed. On the day we put Mubiru in touch with his mother, he asked her when she would come and take him and she said she couldn’t come for him and this really broke his heart. At the time, she had just delivered another baby with her current husband and was not ready to travel to Kampala or take up responsibility for Mubiru.

Today (Feb 2010): We would say that Mubiru has undergone remarkable transformation (as you can see from the pictures). He has had multiple surgeries on his legs, he has had intensive nutritional care and he has grown into a lovely cheeky, healthy boy. He no longer wears diapers and can control his bowels and bladder again; he can feed himself and no longer needs the nasal feeding tube. Mubiru is now receiving physiotherapy to strengthen his muscles and we are training him to walk again. We had braces fitted for his legs which he wears to gradually straighten them. Mubiru’s condition today is much more hopeful than it was about eight months ago when he first came to Hope Ward.

A physiotherapist told me that if you are confined to a bed or if you do not move at all for about three weeks; your body can deteriorate at a very fast rate, and your muscles will atrophy to the extent that you will not be able to walk without rehabilitative physiotherapy. Mubiru was confined to a box and not fed for months; he was left with untreated wounds that transmitted infection to his broken bones. That is why he is unable to walk today. With improved nutrition, tender loving care and good physical exercise, Mubiru will walk again; though this may take a long while.

Presently the hospital ward is not an ideal place for Mubiru to be, if anything he is more exposed to infections from other admitted patients. We have hope that Mubiru will recover and can regain the health and joy a young boy his age should have. However the reality is that his father is now in prison and he cannot return to the people who abused him, broke his bones and left him to die. We are in the process of trying to find a suitable home for Mubiru and we will continue to partner with the home to provide free physiotherapy and any surgery if he needs it to facilitate his return to the normal life of an active and happy young boy. Your kind consideration of our request and compassion for Mubiru will be highly appreciated.

Last year we started using the JustGiving website to make it easy for you to raise funds for our various projects.

In 2009, 5 pages were created and a total of £6,480 raised, thanks to all those who got involved.

We are currently using JustGiving to raise funds for Cancer Care.

You can help by clicking here…

Andrew was brought to Retrak from the International Hospital Kampala (IHK). A week earlier Andrew had been found lying half dead along Kampala’s railway line, a train had hit his left leg and crushed it. The medical staff at IHK were wondering how he could be hit by a train when Andrew began to convulse from fits. It was established that Andrew suffered from epilepsy and must have been crossing the railway when he suffered an epileptic attack. Andrew received excellent care at IHK, but nevertheless needed to have his left leg amputated. Following his operation Andrew could not believe he had only one leg and found it hard physically to adjust his movement and coordination accordingly. It was clear he would need both psychological and physical therapy.

Not knowing his background, IHK referred Andrew to Retrak where social workers and the project nurse provided him with support, counselling and a stable, loving environment. Over time this care enabled him to accept his medical condition, make friends and gain confidence in participating in educational and sporting activities. The Retrak nurse was able to identify a neuro- paediatrician who was able to treat Andrew’s epilepsy and slowly his fits reduced and became manageable.

Following his recovery Andrew felt ready to return home to his family. Retrak staff were still somewhat unclear as to how Andrew ended up on the streets but with him so keen to return home, they set off cautiously to try to resettle him in Lugazi with his family. In Lugazi, nobody there could believe that he had returned and Andrew was so happy, shouting and calling to his siblings “I am back!” Immediately, everyone began celebrating his return, and he is now happy living at home with all his extended family.

*Children’s names have been changed and they are all happy for us to share their story with you

Your support is making such a difference.

Dr. Helena and the Oncology Nursing team Aisha, Joshi, Irene and Maria wish to thank all of our sponsors for their generosity and help. Quite simply each gift means life or a better quality of life for each cancer sufferer and helps to relieve, often immeasurable, suffering.

Thank you also to all those who partner with us and facilitate each person’s care. Rapid appropriate referrals have and will continue to save lives.

• Hospice Africa, who do a great job in finding desperate patients who need oncology support – we currently have 7 patients referred on treatment
• Bless a Child Foundation who partner with us at every level of cancer prevention, treatment and palliative support
• Softpower Jinja who kindly assist with treatment and transport – for 3 children at present
• Corsu – for additional  surgical support
• Dr. Richard Bogle for his generous gifts of support
• Sean Clarke and his customers at Kuvuka Cafe.

We set ourselves a target to raise £25,000 in 2010; to date our total raised is £7,796, which is a great start but we have some way to go… please help, you can give online now by clicking here.

I have only recently discovered this sad news. I would like to thank all that have donated time and money to the Suubi Trust, International Hospital Kampala, and those at Hope Ward that took great care of him during the year of his life that he spent there. Whilst I was there I saw him going from being a very sick little boy to a smiling, happy one, playing with some of his new toys.

Please continue to support Suubi Trust so it can continue to help more of those with serious illness without the means to help themselves.

Jennifer

Enock broke the nation’s heart when he passed away. He was already ”famous’ when he first came to Hope Ward Cancer Clinic having been interviewed and discussed on many national TV and newspaper communications.

FROM: THE DAILY MONITOR UGANDA’S NATIONAL NEWSPAPER

The major deaths of 2009
November 4: Enock Ssebanga, Uganda’s poster-child for torture, succumbs to leukaemia at 21 years. His parents; Mr Charles Kayongo and Ms Regina Nabakoza, who locked and starved him for days in an abandoned store, are out after serving their jail sentences. The Monitor’s August 7, 2000 cover picture of Ssebanga’s scraggy body is a rude reminder of sorts about ongoing parental wickedness in our society.

Enock had advanced disease and sadly died within a year of receiving 6 months of chemotherapy at Hope Ward Cancer Clinic. Dr Helena relates that towards the end, Enock knew he was fading and tried to make his peace with his past and forgive the things that had happened to him.