The New York Times has re-posted an interesting set of award winning pictures by Adam Nadel which capture the stories, science, and sprawl of Malaria. (image 2 shows the magnified head of a mosquito, stunning)

The Many Faces of Malaria – Lens Blog – NYTimes.com.

Northern Uganda to Get Aids Health Care provided by International Medical Group.

East African Business Week | Northern Uganda to get AIDS health care.

Some, most notably The Affordable Medicines Facility-malaria (AMFm), are keen that such treatments become more readily available and accessible to the poor. One would think that such an aim is a good one, a bit of a ‘no-brainer’ but, as I’m learning, things are not always that easy.

There are others raising concerns, such as:

WHO recent guidelines state that malaria treatment has to be based on diagnosis by rapid diagnostic tests (which are both cheap and readily available). This guideline is ignored by AMFm, which will “train” shopkeepers to distribute ACTs to any parent who requests them.

Historical evidence clearly demonstrates that poor people cannot pay for a full course of cheap medicines. Chloroquine was an effective and cheap anti malaria medicine. Despite its low cost, poor people often bought incomplete courses. This was one of the reasons that (the) malaria parasite developed resistance to chloroquine and now the drug is virtually ineffective. AMFm aims to sell ACTs at a similar price to chloroquine but it is unclear what measures will be in place to ensure that ACTs will be protected from a similar fate.

At International Medical Foundation we are also of the view that treatment must be ‘evidence-based’ and we are seeking to find ways to make this work in our community programmes.

We are exploring how we can work with Village Health Teams in the community to achieve some of the successes seen already in Ethiopia and Zambia, as outlined by Dr Mohga Kamal-Yanni of Oxfam in the blog posting linked below:

WHO used to promote a programme of training community health workers on “integrated childhood illness management”. This meant that trained workers could diagnose and treat common childhood illnesses including pneumonia, diarrhoea and malaria.

You can read more of this by clicking on the image below to access Sarah Boseley’s blog at The Guardian.

Related Articles

• Private clinics in Africa to sell essential malaria drugs at affordable prices (guardian.co.uk)

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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.

Turning health into wealth in Uganda – The Irish Times – Fri, Aug 13, 2010.

Dr. Ian Clarke, IMG Chairman, interviewed by The Irish Times:

“What we have been trying to do is to use the income made from our private patients to upgrade the services at both the private hospital and the community clinics, thus positively impacting health services in the country for everyone.”

Read more here…

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.

Sometimes programmes do not go according to plan, regardless of best intentions or the significant needs that we are trying to address. After almost 2 years we have, regretfully, decided to withdraw from our partnership with the District Health Office in Pader.

Pader Health Centre:

A public-private-partnership established in October 2008 by International Medical Foundation with the Ministry of Health, Pader District Health Office and Local Government in Pader to renovate, equip and improve the running of a Health Centre III with the goal of upgrading it to a Health Centre IV.

In addition a project in partnership with the Ministry of Gender, Labour and Social Welfare to provide treatment to Landmine survivors with support from UNDP.

Unfortunately, after many attempts to rectify operational issues, particularly issues related to district staff who were not reporting to work and not co-operating with our Medical Officer, the In-Charge, we had no option but to withdraw.

It is a shame that this is the outcome of a venture that held so much promise but it was not all for nothing. Almost 12,000 people were helped in our time there, as follows below.

Dr. Ian wrote about this outcome for his column in The Sunday Vision: click here to download a copy.

IMF Contribution:

• Staff and technical support to run the health facility. A contribution in 2010 of UGX 22m (£6,200) to cover operational costs for the clinic.

Other Partners’ Inputs

• Funds through Suubi Trust to purchase drugs and meet other costs in running the clinic; UGX 10m (£2,800) in the first half of 2010.
• In the 2008 and 2009 Suubi Trust provided funding totalling UGX 148m (£42,000). Some of these funds were used to refurbish the health centre so it could once again be used to treat patients, service the ambulance and supply solar panels, batteries and the cables for installation of an electricity supply.
• HIPS provided over UGX 16m (£4,500) to help treat those with HIV/AIDS.
• In 2010 UGX 59m (£16,800) was received from UNDP to provide treatment for the landmine survivors.

Project Outcomes and Impact:

Between January and May 2010 1,517 charity patients were registered and treated as IMF patients and 5,688 were treated as Ministry of Health patients, all made possible through our partnership and support. In the last few months of 2008 and throughout 2009 more than 3,500 patients were treated.

In April, May & June 2010, 737 landmine survivors received treatment in Pader, Gulu, Lira, Loro and Anyeke through International Medical Centres. Five patients were sent to Hope Ward – International Hospital Kampala for complex surgeries.

Patient Stories:

You can read about some of the patients that we helped during our time in Pader by clicking here.

Exchange rates as at August 1st 2010.