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Francis is still in a critical situation, though some problems have got settled.

The important problem that looks settled is the air leak, which was causing swelling all over his body and face. Also, he has become more stable lung wise and is mostly off ventilator for over 5 days. He had breathing problems last night and needed ventilator support for a few hours. His left lung is OK and right lung is also partially working. He is needing very low support of oxygen since morning and is breathing by himself.

He is still paralyzed below chest. Can write and communicate. Both upper limbs are OK.

We took him for a CT Scan of chest and neck a week ago. At the same time we did a barium swallow study to assess the status of Oesophagus. They were very informative.

The CT Scan of neck – shows shadow of metallic shrapnel within the spinal cord at the Vertebral level T1, or at the junction of chest and neck. The neuro-surgeons here are of the opinion that it should be removed by surgery and are confident of doing the operation. But he is still not stable for that major surgery.

The CT Scan of chest showed what we expected – the problems with the lung and pleura.

The Barium meal study was done principally because we found that food from his stomach was coming out through the right chest tube. The film clearly shows the barium contrast leaking from the neck (Oesophagus) to the right Pleural cavity/chest. This means that there is a communication between his Oesophagus (Food pipe ) and right chest cavity.

After seeing this, we had to stop giving him feeds through naso-gastric tube and had to start on Total Intravenous (parenteral) nutrition, which is very expensive and having its own risks too. The ENT surgeons and Cardio-thoracic surgeons in this country are not operating on Oesophagus regularly and hence not coming forward to do a surgical correction. Also, it is very risky to operate on neck unless one is experienced and confident. (as it has a lot of vital structures in small area).

Oesophagus is routinely operated in many other countries, including India. So, I had contacted Dr.Radhakrishna P., senior consultant surgical gastro-enterologist in Apollo hospital, Chennai, India, who is a friend of mine. He had advised to do Esophagoscopy, locate where the leak/defect is and close it directly with a covered/metallic stent. We cannot do this as we do not have experts who can deploy Esophageal stents (stent is not available also) here.

So, he advised to do an alternative of surgery to insert a tube into lower part of intestine (feeding Jejunostomy) to give him food, so that he can survive and another surgery in the neck- Esophagostomy/ opening of Esophagus out, so that saliva can be diverted from going down to the chest. The defect can be repaired later when he is more stable. This will improve his chest also.

Dr. Moses has done the feeding jejunostomy 3 days back. But 1 day after the surgery, he vomited greenish(bile containing ) Fluid, which started coming through the chest tube also. This has improved and we have started giving liquid food through the feeding jejunostomy tube.

Esophagostomy is yet to be done.

Dr.Edward (ICU in-charge) was suggesting to get surgeons from abroad to operate on Francis and settle the problems. We are still looking for options. Family was also asking about this possibility. Getting a surgeon from India also is not very easy.

He is maintaining good blood pressure and pulse. Urine output /kidney function is good and is looking forward with hope! So is the family.

Ayo Paska, 28 years old from Paipii village in Lunaa Parish Pader TC, came following a radio announcement in early June 2010 which, her brother in-law shared.

She had a foreign body (FB) in situ and required urgent medical attention as she was pregnant with continued pain from the FB in her.

She was referred for x-ray to determine the position of the bullet at Kalongo Hospital, as Pader HC III still lacks this essential service. She was x-rayed and the bullet removed surgically. Thanks to the good co-ordination and health care provision at both these facilities.

Ouma Moses came to Pader HC III on 3^rd May 2010 with a septic gun shot wound. He is a former LRA abductee and had stayed almost a year captive. He escaped but was attacked and suffered with bomb splinters on parts of his body. He had been receiving treatment, however the wound never healed.

Thanks to the on going Landmine programme, he was reviewed and referred by the SMO Pader HC III for better management at Matany Hospital, where he received full treatment and shrapnel in his rib removed.

Lucy Toobalo a 47 year old mother of five and a primary school teacher from Lamiyo village in Pader district. She was referred to Pader HC III by a CDO following the start of the project on 13^th April 2010. Lucy was travelling from Pader to Gulu when the vehicle she was travelling in hit a landmine at the area of Acoli-buu in 2007.

She came with complaints of discomfort and wounds on her amputated leg causing extended pain.

She said as a teacher, she at times has to stand to explain things better on the board to her pupils most likely causing the wounds. Also, the texture of her prosthesis made her sweat inside at times making it difficult to walk. Clearly Lucy unconditionally loved her profession and her biggest joy was the children/pupils at her school.

On review by Dr. Hillary she was diagnosed with post traumatic pain and recommended to get a new prosthesis, Pader HC III does not have the necessary facility hence she was referred to Buluba Hospital in Jinja.

Lucy is unique in that despite her disability she is always jolly and talks of her career development jokingly she comments that:

“disability is not in ability”.

On her return from Buluba just barely two weeks after Dr. Hillary referred her, she called Stella, the clinic administrator just to inform us with laughter’s saying;

“I am back and on my best foot.”

In my heart there was nothing greater that can bring joy to receive such a feed back. The landmine programme has reached many yet a big number remain out there unidentified and still need treatment.

Rose Lagulu & Oryema Titus are both landmine survivors with amputation of legs and already had prosthesis but complained of developing wounds and pain at the ankle where the surgery had been done. After consultation and evaluation at Pader HC III, both were referred to Buluba for further treatment. Dr. Ziwa our contact at Buluba reported of them getting their new prosthesis with no complaints so far.

We are continually being called to inquire if this programme is still ongoing making it clear that the service is very much needed, appreciated and still many have not been reached.

The turnout at the outreach held on 17^th & 18^th June 2010 in Anyeke and Loro in Oyam district was overwhelming with many being referred to Charis-IMC Lira for further treatment and other more serious cases referred to IHK.

During a recent visit to Lira International Medical Centre (IMC), Kevin Duffy (CEO) and Clea Meynell (IMF Funding and Reporting Manager) spent some time with Trixcy, the Aldo Project Counsellor. Trixcy has been working as a volunteer on the Aldo Project since 2008 providing help and support to Jasper Okwir, the Project Community Nurse. As Jasper is on leave at the moment Trixcy has been covering for him. She is a qualified Nursing Assistant and has a diploma in counselling; skills which have proven to be of great benefit to the Aldo Project.

Trixcy providing education on initiation of ART to a group of Aldo clients

We accompanied Trixcy on a series of home visits to patients enrolled on the Aldo Project. Patients who receive home visits are either too weak or ill to visit the clinic, or as in the case of the second site we visited, Trixcy can follow-up with multiple patients at one time. The services provided on a home visit include one-to-one counselling and advice on positive living and related issues; home-based provision of medication and clinical care (in collaboration with the clinical officers from the Clinic); and health education related to HIV/AIDS.

Joyce’s Story: The first site that we visited was the house of Joyce, a well-educated woman, who in her time, has worked for the likes of UNICEF and the Electoral Commission. Joyce has been an Aldo client since 2008. She is HIV positive and has TB. Initially she was tested and enrolled for treatment at the Lira Regional Referral Hospital but found that there was often a delay in accessing drugs and that the patients were neglected. A friend told her about the service provided by the Aldo Project and she went to enrol. Since then she has been a client. She received treatment for TB at the AIDS Information Centre and is nearly finished her 8-month course.

Joyce in the courtyard outside her rented room in Lira Town

Joyce has no immediate family, she says that they all died of the same problems, and other relatives ignore her. She rents a single room adjoining a quart-yard. With support from the Aldo Project, she informed her neighbours and her landlord about her condition, and enrolled them to help look after her. Recently she fell very sick and was bed-ridden. Her friends, neighbours and even Joyce herself thought that she would die, but Trixcy and the rest of the Aldo Team have nursed her back to health and now she is relatively mobile again. The team visits her weekly to check on her progress and provide her with medication.

For an individual like Joyce the care and support provided by the Aldo Project has literally been life-saving.

Semmy’s Story: Semmy Apoyo greeted us with amazing energy and hospitality under the structure of a semi-built church which was in the process of being constructed near her house. Semmy has been an Aldo client since April 2010 when she came to Lira IMC after trying five times to access HIV testing at the Lira Regional Referral Hospital. After testing positive and being counselled by Trixcy she returned home and disclosed to her family and friends. She rounded up 7 of her close sisters and friends and took them to be tested as well. They all tested positive. One of them was her 11 year old sister.

Semmy (near right) and four of the women she introduced to the Aldo Project

We sat with Semmy and four of these other women whom she had introduced to the project and talked about their experience of the services they had received. They talked of the quality of service they receive from the Aldo Project, something they really value. After some enquiries about their needs, Trixcy took them step by step through use of anti-retroviral therapy (ART) and the importance of healthy living. The educational materials that Trixcy used for this were provided by Mango Tree, and have proven to be very effective in communicating these messages to our community clients.

Trixcy making use of the materials

Joy and Bwine are a humble couple that loves their son Mathew Ayebare (Pictured) deeply and have done their best to take care of him.  Mathew is a little over two years old and has been in and out of hospital since he was a year old.

Joy noticed that Mathew at nine months did not seem to respond or behave like her other two children. However, she did not read too much into it at the time. When he made a year, Mathew started getting seizures. When he was taken to hospital, they were told he had epilepsy and he was started on treatment.  But the seizures did not stop.

The anxious young parents took Mathew back to hospital where he had a CT scan that revealed bleeding in his brain. This is when they learned that their son had a very complex and rare congenital defect known as arteriovenous malformation. An arteriovenous malformation (AVM) is when there is abnormal connectivity between arteries and veins.

www.brain-aneurysm.com says that most brain AVMs present with a brain hemorrhage (severe headache, nausea, vomiting, and collapse/loss of consciousness). Instant death rate is believed to be at about 10% for first-time hemorrhages from a brain AVM, and this is about the same as the instant mortality rate for first-time brain aneurysm ruptures. Many AVMs present with seizures, and some present with neurological symptoms (paralysis or sensory disturbance) due to the mass of the blood vessel tangle causing direct compression of brain tissue.

Joy and Bwine desperately needed a “miracle” for their son.  They were referred to Dr. Hussein Ssenyonjo who agreed to perform the operation. However, it would be a very complex operation with a long stay in Intensive Care after the operation. The family could not raise money to have the surgery done and; so, they approached Hope Ward at International Hospital Kampala.

Hope Ward is a charity ward at the International Hospital Kampala that partners with various companies, organizations and individuals to provide complex medical treatment for the very needy in Uganda. Sponsors include Bead for Life, Muvule Trust, Stanbic Bank, MTN, Narrow Road, Hwan Sung, Suubi Trust, Bless a Child Foundation, IAA Health Care and the International Hospital Kampala (IHK).

Mathew was admitted to Hope Ward and had a successful surgery at IHK. His family was only asked to contribute Shs 2m out of a total of Shs 6.2m.  The International Hospital covered 30% of the  bill and does the same for all Hope Ward patients. The balance was covered by donations from Hope Ward supporters. Dr. Ssenyonjo waived his fee and his only concern was saving Mathew’s life.

Before surgery, Mathew had a 10% chance of living but his future is much brighter now.

1. Sustained fracture of his right femur and multiple perforations in his intestines. Pain is controlled. Can take oral feeds. Steadily improving.

2. Had abdominal surgery. Pain controlled, he can eat and move out of bed. He is much better. Getting nightmares and sleeplessness. Put on medication. Slept better last night. Much better.

3. Had abdominal surgery. Pain controlled, he can eat and move out of bed. Marked improvement. Has shrapnel in his pelvis. Surgeon to determine need for surgery.

4. Severe head injury. Still unconscious but responds to pain by opening eyes. Had fever free night. Some improvement.

5. Had abdominal surgery. Pain controlled. She can eat and move out of bed-much better. Broken finger operated 2 days ago.

6. Sustained head injury. Her sight is steadily improving. Power in her arms is also improving. May need surgery to remove shrapnel form her skull. Surgeon to determine.

7. Sustained spinal, neck, airway and esophageal injury. Got air leakage to the skin and body swelling. Body swelling has reduced markedly and can move his arms. Patchy sensation in the legs. Will need surgery to close the hole connecting his airway and esophagus and to remove the shrapnel in the neck when he is stable.

In May 2010, I developed cough, severe chest pain, diarrhoea and weakness. My son supported me on his bicycle to the clinic. I was weak, in severe pain, I couldn’t walk, and I was in a confusion state. People in the Village thought that I was not going to come back alive.

The clinic staffs organized for my transport and I was rushed to Hope Ward. I am grateful to Management of IMF, I was treated freely, fed and well taken care of. I thank Management of Royal Van Zanten and clinic staffs for their support. I can now work in my garden and take care of my children.

The environment in Hope Ward brought a smile in my face.
Hope Ward gave me hope to carry on.

The Chairman LC1 had this to say;

I thank IMF, Royal Van Zanten and the clinic staffs for the Good work they are doing in our community. Most of our people are affected with HIV and treatment is very expensive of which they cannot afford. Thank you for helping Nagawa, you gave her hope to continue taking care of her children.

In July 2010, I developed severe diarrhoea, fever and vomiting. I was rushed to the clinic in bad state. I could not walk, eat or drink. I was very weak and had lost hope in life. I knew I was going to die.

Royal Van Zanten management arranged for my transport and I was rushed to International Hospital Kampala Hope Ward. With support from IMF, I was treated, fed and well taken care of freely. I stabilized after a few days and was discharged in good condition. I can now walk and eat.

I thank Management of IMF, Royal Van Zanten management and the clinic staff for their support.

Regina’s mother had this to say:

I had lost hope. I thought my daughter was going to die but when I reached the hospital I knew she will survive. I thank the Management and all the staffs of hope ward for their spirit of hospitality.

‘IMF brought back hope that was lost.’