As I write this column I am sorrowful, because I have lost a good friend and a good man. Moses Munezero was killed in the night bus ambush which happened on the Mbarara- Kabale road this week.

He was a young doctor working in Lira who first worked on a community HIV project in Hima and then moved to Lira to help me set up a clinic, where we not only treat those who can pay, but hundreds of charity patients and those with HIV.

I visited him four weeks ago and he was excited about the possibility of extending the clinic to have a theatre to carry out emergency caesarean sections and other operations. Moses was the kind of person whom one depended on, because he was steady and never let people down. He was that rare breed of person who was truly unselfish and spent his life helping others. He wanted to be good at what he did and considered the patients more important than his own personal needs.

Moses represented the very best of Uganda, in these days when we hear a lot about corruption and Ugandans who are in a hurry to get rich quick by any means. He was a role model, the kind of person you would be happy for your daughter to marry — competent, serious-minded and compassionate. He was a Ugandan who restored hope when one was tempted to feel the society was rotten. It is this which makes his death all the more tragic — because he was killed by Ugandans who illustrate the level to which our society has fallen.

The thieves placed big stones across the road, which the bus crashed into and then overturned, killing at least five people and injuring many. The thieves were not appalled by what they had done, but boarded the bus and systematically robbed the dead and the dying. The worst of society had killed the best in society. Is this the kind of place that Uganda has become?

We have so many good people, but they are being pushed aside by those who have no conscience, feel no tenderness and show no mercy. Uganda has been here before — when the State Research Bureau disposed of people as if they were pieces of meat; we have only just got rid of the menace of Kony, but now it has become dangerous to do everyday things, like taking a bus ride at night.

One of the main purposes of government and civil society structures is to maintain law and order, so that people can go about their daily lives without fear of molestation. The death of Moses is an indictment of these organs of society. His death was due to a combination of lack of law and order and lack of care by the driver and the operators of the bus company. If the driver had been going more slowly within the speed limits, he could probably have seen the stones and stopped. If policing is now so weak, that thieves can operate with impunity along a major highway, then the system is ineffective.

The combination of these two deficiencies resulted in the death of a fine young Ugandan, and let us not kid ourselves, this death could have been avoided. But will anyone take responsibility? Will the Police, who have failed to enforce speed regulations on the buses and to patrol the road? Will the government, who have allowed an incipient lawlessness to take hold, which breeds violence and death? Or will everyone just shake their heads and agree that it was a tragedy, while we wait for the next hold-up or next bus accident to happen?

We are losing the good people in our society, because we are failing to control the worst elements.

Published on: Saturday, 19th December, 2009

THIS week we celebrated World AIDS day. Though celebration is hardly the right word for such an occasion, it was an opportunity to highlight the fact that AIDS is still with us and take stock of the progress which has been made in combating this epidemic. In Uganda, the picture regarding AIDS is mixed — we have taken some steps forward and also gone backwards. The overall rate of HIV is now lower than it was 10 years ago, so that is progress. But more new cases are arising, so we are going backwards in that area. Surprisingly many of these new cases are in married couples or people in stable relationships and the risk of infection within a married couple is now twice the risk of infection through a prostitute!

The reason for this is that there are so many discordant couples — where one partner is positive, but the other is negative. This may be because one of the partners has another relationship, or that they were already positive when they commenced the relationship. Either way, as long as the couple are having sex, they are sitting on a time bomb. There are all sorts of possible combinations and permutations in sexual relationships and the permutations don’t get much more complicated than in Uganda. In this country, we have people with wives, co-wives, side-wives and girlfriends. Relationships may be described in terms of monogamous, serially monogamous, polygamous, informally or serially polygamous.

With all these different types and combinations, it is no wonder that AIDS is still an issue and in the face of discordancy within such networks the old message of Abstain, Be faithful or Use a condom is inadequate. The International Agencies have been looking for new ways to communicate the issue and someone came up with the message — Get off the sexual network, which for ordinary Ugandans must be one of the most obscure messages about AIDS they could have dreamed up. The message is a bit too subtle for most Ugandans — it sounds like getting off the London underground or Facebook and how does one apply it to real life? If people are already in complex relationships, they are either in that situation unwittingly because they do not know what their partner is doing, or they are aware that they have more than one partner but continue because they enjoy that lifestyle. Either way, telling them to get off the sexual network is meaningless and the simple message is — don’t have sex with anyone unless you know their HIV status, even if you have been married for many years. This means that you not only need to test yourself, you need to take your partner with you, and if they refuse, then stop having sex, or protect yourself by using a condom. This is an issue which you cannot leave to trust, it is a matter of life and death and if you don’t take the decision the death will be yours. If you are the person in the relationship who is positive, you must also ensure that your partner is protected, which you can do by using a condom.

For this World AIDS Day, the message should be straight to the point — don’t have sex with anyone, even your husband or wife, unless you know their status. It is your life and it is your responsibility to protect it. Don’t put your life in the hands of your partner, because all too often, if you happen to get infected, they will deny that it was from them and then blame you for bringing HIV into the relationship.

Do a test with your partner and know their status.

I extend my regards to Dr. Ian Clarke, Dr. Ben Khingi; all Doctors & Nurses of Hope Ward, all companies involved in giving out part of their resources to bring Hope to the needy People of Uganda. Without you all, life would be totally different from what it is today.

Thank you very much and may the Lord reward you for your care & Kind heart.

Yours faithfully,

Nkonge Geoffrey

Acid Victim

What was just an empty field now contains a 110 bed hospital, many out-patient departments, a large pharmacy and 3 labs, serving more than 75,000 patient visits each year and of course the university.

Well done Dr. Ian.

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I first came across Ian Clarke through a viewing of the ‘Longest River’, when he joined the rafting crew down the Nile (see previous blog ‘Quite Bright and Filming’). Watching him in action, I was impressed by his commentary and observations while passing through the conflict zones of South Sudan, and particularly with his leadership ability within the team. So when I heard about his work in Kampala, I was eager to track him down.

Ian, an Irish medical doctor, originally came to Uganda as a GP and from there set up a rural hospital North of Kampala. His work there showed him the need for high quality medical service provision across the country. He was also eager to show that when it comes to the medical profession that ‘quality’ and ‘Uganda’ can be combined. ‘I decided that my goal was to start a hospital in Kampala and raise medical standards’, he commented. ‘But this time, instead of targeting the rural poor, where I had been working, that I would target the emerging middle income group, and use the money that they pay to upgrade the services and thus effect the overall health services’

So emerged ‘International Hospital Kampala’, a private hospital which provides specialist services in the city. Included are Oncology and Plastics departments, and a nursing school.

‘So it means that you can have a third world country, but it does not mean that it is third rate’, he added-with pride.

The hospital is now at a stage of attracting private sector sponsorship to support a charitable ward in the hospital, so that people who cannot afford the services can still access them. (Since then of course Hope Ward has been implemented and has treated very many charity patients… KFD)

There are also has plans for a medical university, so as to raise the bar on training, and to expand clinical services regionally.

‘The core value is making a difference- and if you are making a difference, you are bringing hope. The ideal of wanting to make a difference, is wanting to multiply ourselves. We are not there just for our service, even making the competition buck up a bit, but we want to take some of the principles we learned and teach other people’.

It has been an intense few years for Ian, who himself has had a battle with illness. I asked him what has kept him going.

‘I have a very strong belief in people, and I think it is my belief in people which enables me to do what I do’, he added. ‘Plus some of it is just determination. You don’t give up and you don’t expect to make huge strides at once. Things happen incrementally, and then you look around in a couple of years, and say, yes, look at what we have done’.

Our Treasurer, Steve Taylor, has been preparing the 2008-09 accounts (April 6^th to April 5^th) and we thought that you might be interested in learning how much was raised and what we’ve done with it. It’s probably worth reminding you that:

• All money received by Suubi Trust is used to support the work in Uganda. We make no deductions either from your contributions or from tax relief claimed through Gift Aid.
• Our trustees are volunteers who do not charge for their time, or claim any payment or expenses. We have no administration costs.
• Operational costs for Hope Ward and the charity clinics are subsidised by Dr. Ian Clarke. Suubi Trust does not pay rent or contribute to the capital costs of establishing this required infrastructure.

You helped raise a total of £73,300

These funds were used to support and provide:

• Primary healthcare for more than 2,500 patients and an immunisation programme for young children at the Lira Health Centre:- £18,000
• Complex healthcare on Hope Ward; on average there are about 6 in-patients being treated at any one time, though we have capacity to treat as many as 15 if we have sufficient funds:- £5,600
• Cancer Treatments on Hope Ward; at times there can be as many as 15 outpatient day case chemotherapies each week:- £6,200
• A new charity based Physiotherapy clinic treating patients with complex, long-term rehabilitation needs:- £820
• The purchase of essential equipment for Heart Surgeries:- £350
• Contribution to other International Medical Foundation projects, including a large HIV-AIDS outreach programme into the community living in and around the Hospital and a TB Lab which is now close to completing a clinical trial for a new low-cost, fast diagnostic test:- £17,217
• The opening of a new Health Centre in Pader, Northern Uganda, which has treated, free of charge, 1,652 patients since last October:- £25,113.

In recent weeks I have had the great pleasure of meeting again with the team members providing this care at International Hospital Kampala and at the clinics in Pader and Lira. Their dedication and professionalism joins with your generosity to make a difference in the lives of so many.

Thank you so much for your continued support.

Kind regards,

Kevin.

Chairman: Suubi Trust and International Medical Foundation.

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International Medical Group is the leading private provider of health care services in Uganda. There are three main divisions to the group and the model is similar to HMOs in the USA:

1. IAA Health Care provides Health Schemes to employers for their employees and families and also some personal schemes . These schemes meet the costs of any treatments required. There is no NHS in Uganda. Members can get treatment from IMG, or from a number of selected medical service providers.

2. International Hospital Kampala, the largest private hospital in Uganda, provides care for IAA members, for those with health insurance and for cash and invoiced patients. IHK has 100 beds for in-patients, plus general outpatient and specialist clinics. It is the country’s first ISO certified hospital.

3. International Medical Centres has 13 community based Health Clinics throughout the country. These provide primary health care, similar to a GP Surgery in the UK, and refer patients to IHK as needed. Some of these are stand alone clinics and others are in large Factories and Schools.

IMG employs about 530 people and has more than 100,000 clients.

IMG provides staff, facilities and infrastructure to International Medical Foundation to support and enable its charity and grant funded projects.

In 2008, IMG made a financial contribution, to these charity projects, of more than £80,000.

We are also very happy to have strong partnerships with committed and dedicated people and other reputable organisations such as VSO, Hands of Help, Simon Friend, HIPS, Target TB, Civil Society Fund, Percuity and of course Suubi Trust, who are our key partners in raising awareness, keeping people informed and bringing together other groups to fund raise and support the various projects in our portfolio.

The beauty of all of this is that together we achieve a significant impact for very little cost. Consider all the projects which we are now carrying out.

In Kampala:

• Hope Ward at International Hospital for the treatment of complex conditions for the destitute
• TB project carrying out the first validation in East Africa for MOTs diagnosis of TB (a low cost method of culturing TB)
• Touch Namuwongo Project providing voluntary counselling, testing and treatment for HIV and TB
• Open Heart Surgery programme at IHK
• Cancer treatment programme at IHK.

In the East of Uganda (Jinja):

• Community based healthcare project.
• Royal Vanten Flower farm community HIV project providing counselling, testing and treatment.

In the West of Uganda:

• Kasesse Cobalt Co community HIV project providing testing, counselling and treatment.

In the North of Uganda:

• Gulu Clinic – carrying out a limited amount of charity treatment
• Lira Clinic – carrying out charity treatment and a HIV counselling and testing project
• Pader Clinic – providing free treatment and the rehabilitation of a government health centre.

All of these projects use the infrastructure, expertise and corporate capacity of International Hospital and International Medical Centres and therefore do not have to sustain the high establishment and capital costs which would otherwise be involved.

I would particularly like to thank Kevin and his team, Helen Lay from VSO who keeps our finances organised and Jemimah Kiboss the programme coordinator who keeps tabs on all the projects.

We are grateful to every one of our supporters, without whom much of the above simply wouldn’t have been possible. Thank you for all that you have helped to achieve in 2008 and our best wishes to you and your loved ones for 2009.

Regards,

Ian Clarke

CEO International Hospital.

In November Dr Ian Clarke, CEO International Medical Group, was invited to address the “U.S. – Africa Private Sector Health Forum” in Washington, USA.

In his presentation he outlined how his team at IMG has been serving the people of Uganda for more than 12 years and discussed what comes next. Dr Ian is a very keen advocate of the Public and Private sectors working together to provide excellence in Health Care, meeting the needs of those less able to provide for themselves.

We at Suubi Trust are very proud to be working with Dr Ian and helping to support his charity based initiatives.

The presentation provides a quick overview of the work at IMG and can be downloaded here in two versions, a large file with pictures, for those on Broadband, and a smaller file without pictures for those on slower connections.

Health is a complex issue and there is no simple solution to taking care of the health needs of any nation. Uganda has a population approaching 30,000,000, with over 50% of people below the age of fifteen. The prevalent diseases are not the degenerative diseases, which mainly affect developed countries, but infectious diseases and diseases such as cancer which now affect people at a younger age because of the influence of HIV on other disease patterns. This is not to say that Ugandans do not suffer from ‘western’ conditions such as heart disease, strokes and arthritis, but relatively fewer of the population grow old enough to be at risk.

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The emphasis of IMF working through IMG is not only to provide the primary healthcare in the form of preventive healthcare, such as immunisations and the distribution of mosquito nets, but to have the necessary referral facility, such as a laboratory and theatre facilities. Another goal is to ensure that standards are implemented and upheld. This requires competent well trained personnel and appropriate well maintained equipment. It is for this reason that IMG is involved in medical and nurse training, including quality assurance and medical management and building the capacity to fill the gaps at both secondary and tertiary levels.

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Many Ugandan medical professionals have either left the country, or will leave, because of lack of adequate facilities for training and gaining experience. This brain drain has a serious impact on the ratio of doctors to the population, but one cannot blame them if they cannot obtain sufficient experience within Uganda. Undertaking such high level procedures, such as heart surgery within Uganda brings back hope to many medical professionals that there will be more medical development in the future.

IMF and IMG are about facilitation – facilitating the individual patient to access appropriate treatment, facilitating the medical professional to provide that treatment at correct standards and facilitating the building of capacity and closing the gaps within the healthcare profession in Uganda.

You can read the full paper by clicking here…

http://www.belfasttelegraph.co.uk/features/daily-features/article2437599.ece

Dr Ian Clarke, from Northern Ireland, has spent 20 years working as a doctor in Uganda, where death is a way of life – and something he has had to face himself. UTV’s Paul Clark met the extraordinary GP turned bush doctor for a documentary being screened.

Dr Ian Clarke’s autobiography has a peculiar title – The Man With The Key Has Gone. He chose it because of his frustration with Ugandan authority, as he attempted to establish a clinic in the African bush.

Ian has lost count of the number of times he reached an office or store, sometimes after many hours of driving, and often with an urgent need for some medical supplies, only to be told: “The man with the key has gone.”

It reflected not just a problem in bureaucracy, but an attitude to life in general. His colleagues would seldom complain. They accepted that the store, or office, was closed.

“Why is the store closed?” “Because the man with the key has gone.” End of story.

That is the environment in which Ian Clarke, originally from Northern Ireland, has chosen to work for the past 20 years. He is a GP turned bush doctor.

His first clinic in Africa was held under the trees. Then it moved to his house, and finally to a purpose-built clinic.

That clinic was located in an area known to the outside world as the ‘Lowero Triangle.’ It was the centre of the killing fields of Uganda, during the country’s civil war.

And, it was into this district that Ian Clarke, a missionary doctor, had travelled, in 1987.

There were many times when he struggled to keep control of his emotions – thousands of miles from home and surveying the devastation of a war which was barely over.

Little did he know then just how deeply his destiny would be linked with Uganda.

He admits that if he had been able to gaze over the vista of the following years, he would have been crushed.

“If I had been able to see the dimensions of human suffering, disease and death which we would face in the future, if I had known that sickness and death would touch our dearest friends and that finally I would not be immune myself, I would have wanted to turn back there and then,” he says.

Ian Clarke was not an experienced gynaecologist or surgeon, but the experienced people were not there. And he was the man on the spot.

People had heard there was a doctor in the area, and they just kept coming. They had faith that he could do something, but Ian knew his limitations.

He recalls: “A mother had delivered a baby in the middle of the night, by the side of the road with no help, and it had died. The family were so grateful for my help, but what had I done? I had come too late.

“I marvelled at these people. They had so little. A few bundles of clothes, a few saucepans, nothing that we would consider of any value. I had let them down because I hadn’t got there in time to deliver the baby. Yet, they had a graciousness of spirit and a sense of thankfulness which touched my heart and made me feel small.”

This was one of many incidents which frustrated Ian. It was these feelings of inadequacy which made him want to do more for the people. That clinic, which he set up 20 years ago, has now grown into Kiwoko – a mission hospital based in the Ugandan bush.

Today, the hospital is in the epicentre of the AIDS pandemic. Death is a way of life with which we are not familiar in this country. And Ian has had to face death himself. He has been diagnosed with cancer. Currently, he is in remission.

The hospital he founded is now a partner with Makerere University in Kampala, the Ugandan capital. Students from the capital are trained in rural medicine. After all, most people in this central African country do not live in towns and cities, but in the bush.

There is even a link with Queen’s University in Belfast. A nurse tutor from the mission hospital has recently returned to Kiwoko, after receiving further training in Northern Ireland.

Ian has even greater ideas. He is planning another hospital in an entirely different part of rural Uganda – in an area where the Lord’s Resistance Army is rampant. Post-ceasefire, he is working on rural health programmes in Southern Sudan. But the legacy of this local doctor is Kiwoko hospital. Its success is that Ian has taken a back seat. He is no longer involved in its operation.

Those who work in the hospital are mostly Ugandan. Increasingly, it’s being run by locals, but a number still come from Northern Ireland where the vision of Dr Ian Clarke endures.