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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.

This video features Dr. Richard and I am so glad to hear him say that he got as much from his time here as we got from him, which believe me was massive. His influence continues through his ongoing support for our TB Lab and community hospital in Lira. We need more like him…

The BMJ nominated us winners for the
“Getting Evidence into Practice”
award.

The TB Diagnostics Lab was the very first project that I became involved in at International Medical Foundation, back in 2007. I remember being approached almost every day by Dr. Mark Russell (a VSO volunteer) who wanted to do something for the many HIV/AIDS patients that he was needing to treat for TB. He had come across a new diagnostic method, *MOT – MODS, that had recently been used in Peru and he thought it would be perfect for Africa; and so it began.

Dr. Ian Clarke offered some space and building resources for a new lab at International Hospital Kampala and agreed that Bosco, one of the hospital’s microbiologists, could allocate some of his time to working with Mark.

I had just started Suubi Trust and agreed that we would raise the £15,000 that was needed to equip the new lab.

The lab was opened on Wednesday August 1st, 2007.

In Q4 2007, Dr. Grania, also from VSO, took over from Mark and started to work with Bosco and the IHK team to perform the clinical trail to validate the methodology and local processes. Early in 2008 this trail received a huge boost when the team secured additional funding from Target TB.

In 2009 Dr. Richard, VSO, joined the team and helped Dr. Edith and Bosco to complete the trial. In August 2009 he helped to train local volunteers, CATTS as we started Phase 2 of the programme, with a particular focus on treatment in the community.

Then in March 2011 we heard that we had been shortlisted for the BMJ award.

It’s been a great team effort. On hearing the news Grania said: “The TB team at IHK should be very proud of themselves, they have worked very hard and its great that their hard work has been publicly recognised.”

Dr. Richard and his wife Pat were able to attend and collect the award:

“This award is for all the Ugandan volunteer workers and village health workers who worked so hard with us to improve the lot of their community.  In a land where this is so much unemployment and pitiful wages this a completely different ‘Big Society’ “

This is a programme that we can all be very proud of. For me it was great to be involved at the very start. Thanks to Mark and the original Suubi Trust sponsors who helped to get us started. Thanks to Target TB for its support of the clinical trial. Thanks to VSO for encouraging doctors to come here and help.

Most of all thanks to Bosco, Edith and the Touch Namuwongo team for the daily implementation of health education, preventative measures, diagnostics and treatment, which is making a huge difference in the lives of those living with HIV/AIDs and TB.

*Microscopic Observed Technique (MOT) is a low-technology, low cost ($5) liquid culture-based methodology performed directly on sputum samples to diagnose Tuberculosis. It is simple to implement, especially in the developing world, and the programme is now run by Ugandan doctors, clinical officers, TB nurses and an increasing number of trained volunteers. This has led to increased rates of diagnosis and treatment of TB, and opening the doors to better management of TB not only in Uganda but across Sub-Saharan Africa.

Read more about this programme by clicking here.

Thanks to Dr. Richard for making the submission.

TB is a significant health issue in Uganda and our project, supported initially by Suubi Trust and then by Target TB, has implemented a new TB Lab and completed a clinical trail for the MOT/MODS diagnostic method. You can read more detail about this in the submitted report by clicking here.

Essentially this method enables the team to diagnose TB in about 7-10 days at a cost of just $5. This compares to either the gold standard MGIT test which can cost up to $70 per test or low cost methods that can take about 40 days for a result.

Our thanks to VSO for it’s support over the last few years, first with Dr. Mark who got us started and then Dr. Grania and Dr. Richard who between them managed the clinical trial and the integration of the TB Lab into IHK’s community based health programme Touch Namuwongo.

Read our other Blog posts about this project by clicking here.

The first project that Suubi Trust supported was the development of a level 2 bio-containment facility at International Hospital Kampala to provide a MODS TB culture and sensitivity service. That was back in July 2007.

Since then we have completed the clinical trial and are now using the method to help diagnose patients from IHK and from our community programmes such as Touch Namuwongo.

This work has been supported over the last 3 years by a number of dedicated volunteers including Dr. Mark Russell, Dr. Grania Brigden and Dr. Richard Feinmann. They have worked alongside the local team including Dr. Edith and Bosco, who can be seen in the photo working with some cultures.

TB killed an estimated 1.7 million people globally in 2009, it is the biggest killer of HIV/AIDS patients in Africa. This new method helps us to get an accurate and cost-effective diagnosis much more quickly than before; for our TB patients starting the right treatment quickly is very important. You can read more about our work with TB patients by clicking here.

Photo by VSO/Ben Langdon

This is Dr. Richard as many of us will remember him, enjoying being with the kids on Hope Ward. He made a huge difference in his time with us as a voluteer with VSO. There are more photos of him on the VSO website here.

Even after their VSO stint was finished, Richard and Patricia continued to help, encourage and support us. They came back for an extra 3 months to help us move into a larger health facility in Lira, northern Uganda and are now helping to raise funds for our maternal and child health programme there.

Here’s what Dr. Richard says about working with VSO:

“I hadn’t realised VSO would want people of my age. All my VSO contacts went overseas straight out of university, so I was a little tentative when I contacted VSO and said “I’m an old git, I have reasonable health and these talents, are you interested?” And I really did expect them to say no but was pleasantly surprised.”

It had been a busy day in the community sexual health clinic and we were all feeling tired and hungry. It had been a long day too for Jane, our last patient of the day, not that she allowed us to think that for a moment. She entered the room in a composed and quiet manner and thanked us for seeing her. I asked her what had brought her to the clinic that day and bit by bit her story unravelled.

Jane is a 20year old orphan who lives and works in Kampala and is the sole carer for her 2 younger siblings. She earns £30/month at a local supermarket, where she works every night until 8pm in order to provide food and school fees for them. What little time and money that Jane has left she devotes to completing a certificate in accounting which she hopes to finish next month.

She calmly told us that on her way home from work one night 2 months ago she was gang-raped by 3 strangers. During this bloody ordeal, she was robbed of her virginity and now has a profuse vaginal discharge that has left her too embarrassed and fearful to go out in public.

Reeling from her sad story and yet in awe of her courage and determination, I gently proceeded to ask her more questions, and found that she had missed her period last month. A pregnancy test confirmed her worst fears. As if her violation, a pelvic infection and the threat of HIV were not enough, she now also has to cope with a pregnancy. It was only at this point that Jane broke down.

Although termination of pregnancy is illegal in Uganda, many would have thought this to be her only option. However Jane, despite barely being able to support herself and her siblings, would not consider such an avenue. In her own words, she said:

I would rather take my own life than abort this baby.

Her financial hardship is likely only to get worse when her employers discover that she is pregnant and dismiss her from her job. Jane expects no financial help and is simply grateful for the medical care we can give her, but touched by her plight and humbled by her inner strength we are keen to try and support her in this direction too. If you feel likewise, you can donate through Suubi Trust: giving options are on this page or you can give online by clicking here. Please mark your donations ‘for Jane’.

The most humbling moment for me was at the conclusion of our meeting, when despite all the heartache that had been thrown her way, Jane met my eyes and said:

Thank you so much. May God bless you.

Dr. Alison is working with us at International Medical Foundation as a volunteer through VSO; you can read more about her work and experiences on her Blog by clicking here.

Today when I went on my daily visit to Francis and a few others in ICU I was astounded when Francis physically lifted his hand, took mine in his and shook it. He then intimated that he was requesting continued visits!….a very clear intimation to me that this is a man with incredible spirit, motivation and determionation to get out of this and is slowely showing small steps of improvement.  What about a few emails of support for him?  would that be appropriate for readers of this site to write a few words to motivate him.  I will happily take responsibility for printing off and taking to read to him.  It would also be a tremendous support for his family during the long road ahead. anyone who would like to offer him a bit of motivation my email is dianel(ATSymbol)img.co.ug.  Also Alice is a lovely young lady who has had a long struggle with brain swelling who could also do with a bit of motivation.  Please feel free to email as appropriate
Many thanks

Here is the earlier posting about Francis.



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!