Thursday, October 19, 2017

Medical camps are the only hope for the poor to meet specialists

Dr. Ben Watmon examining  Rwot's eye at Nebbi hospital
By Esther Nakkazi

He was quiet and frail.

The three-year-old, little boy, had an eye problem, and obviously had not enough sleep the previous night. Living 50 kilometers from Nebbi hospital, father and son had to wake up at dawn to be the first in the queue.

Still, little Jonathan Rwot was almost at the end of the long line that mostly had elderly people. He was sitting on his father’s lap. Never raising his head. Starring at the floor with his head slightly bent down all the while.

It was one of the hotter days. Rwot could have been playing hide and seek or kicking a fiber-made football with other kids but here he was waiting in the long winding queue.

He had to have an examination; an operation and a referral. He was not only suffering physically but emotionally too. He was small, with a scary, protruding eye and undernourished. Such a pitiful sight. It was not his turn but he got pulled out of the line. That was luck.

“He might not live beyond five years,” said Dr. Ben Watmon an ophthalmologist. He was using an ophthalmoscope to shine a bright light into Rwot’s eye as part of the examination. Only then, did Rwot, for three years look straight into another person’s eyes for a long time.

Gilbert Onegi, the father was not fixated on the details of the diagnosis. Really, just some concerns loomed; If he could get his son out of pain, to play with other children and sleep with his eyes closed without crying at night. Maybe the emotional pain would go away too.

Dr. Watmon asked gingerly how and when the problem started. He probed. But Onegi had no exact answers.

It supposedly started when Rwot was four months, said Onegi. But his boy got no medical attention. His mother did not have much time or love for Rwot. She later found another man and abandoned her young son.

By the time Rwot was brought to his father two years after he was born, the tumor within the eye was fully grown. He was lonely. Kids didn't play with him. They shunned Rwot. But he never cried in front of them - just watched them play.

At night, Rwot’s sick eye did not close. It glowed like a cat’s eye in their pitch black small, one-roomed grass thatched hut. Rwot did not sleep much and only at night did he cry, Onegi said.

Rwot was diagnosed with retinoblastoma, a cancer that starts in the retina. It is a common eye cancer in children and can be sporadic or hereditary. If not treated early the tumor grows outside of the eyeball. Exactly what happened to Rwot.

“The clinical appearance shows the cancer is in advanced stages,” said Dr. Watmon who was at Nebbi hospital for a medical eye camp. “At the camp, I do not look at itching eyes. My main work is surgery. Rwot has had a chance,” he said.

He explained that the camp is a bridging gap for the rural poor who may never afford or have a chance to see a specialist. But he cannot offer his specialized services to this Nebbi community all year round.

Based at Gulu hospital, about 70 kilometers away, Dr. Watmon is also the one ophthalmologist in charge of the whole mid-northern region with millions of people. That is not strange. Uganda has only 48 ophthalmologists, according to their umbrella body, the Uganda Ophthalmology Society.

Eight have since retired leaving only 40 to serve an entire population of 41 million people. 26 of these remain in the country’s capital, Kampala. 14 like Dr. Watmon serve the rural populations in rural or 'hard to reach' areas.

Many hospitals out of Kampala, Nebbi inclusive, lack specialized services. So conditions that could be treated early and reversed go untreated until the ‘arm of God’ presents breakthroughs like the medical eye camp.

The Uganda Government tries to solve the problem by partnering with non-governmental organizations to provide such services through medical camps. For this eye camp, its partner was Amref Health Africa, Uganda branch.

But the demand for specialist services for each hospital is different. For instance, in 2016, Nebbi hospital registered 49,809 outpatients. 2.3 percent or 1,180 were eye patients, said Dr. Charles Keneddy Kissa the medical superintendent, Nebbi hospital.

“We have one ophthalmologist officer who can only handle minor eye cases such as allergies although the hospital has a beautiful eye clinic, which has not been used for 10 years,” said Dr. Kissa.

They have tried to find an ophthalmologist doctor. “We have advertised many times but got no interested candidates,” said Dr. Kissa. Undeniably, this is a 'hard to reach' area and with no incentives, doctors are not eager to work there.

As such, conditions like glaucoma, refractive errors and cataracts, which most of the people in the line waiting with Rwot have, cannot be reversed and cured because they cannot be intercepted early.

Another solution could be getting an eye donation but organ transplant in Uganda is illegal.

Dr. Watmon had two solutions for Rwot; first to put him on chemotherapy then remove the eye or remove the eye and do chemotherapy. He opted for the latter and referred him to Ruharo eye center, the only facility in Uganda that gives free eye chemotherapy services for children.

But it is in the western part of the country while Rwot lives in the northern part.

However, there is hope. If his case is forwarded to Ruharo, as a referral, transport money will be sent to Onegi to take his son for free chemotherapy.

But at Nebbi hospital at least the journey began. Rwot’s operation was among the 42 Doctor Watmon carried out during the five-day eye camp. 106 patients were examined but some were not as lucky as Rwot. They walked long distances back home to wait for the next eye camp.

“At least Rwot will be free of pain,” said Dr. Watmon. He will sleep with both eyes closed.


This article was made possible by Amref Africa- Uganda

Wednesday, October 11, 2017

Contraceptives for teens? Immoral but they are having sex!

By Esther Nakkazi

On the International Day of the Girl Child, Uganda is struggling with what to do with her girl child. At the tender age of sixteen or less, the average Ugandan girl is having sex. But do they need contraceptives?

According to studies, Uganda has one of the highest teenage pregnancy rates in sub-Saharan Africa. By ages 15-19, one in four Ugandan women is already a mother or is pregnant and later in life from age 15 - 24 years - the burden of HIV is high - Uganda has the second highest rate of HIV infection among women.

To wisely address this issue Uganda revised its fourth, 2015, policy, National Guidelines and Service Standards for Sexual and Reproductive Health and Rights.

After 18 months of adequately engaging all stakeholders including district leaders, service providers, religious and cultural leaders, with Uganda's Ministry of Health, particularly its reproductive health department, spearheading the review process, the Guidelines were ready to be launched.

They were, duly, signed by Uganda's Ministry of Health acting director general of health services, Prof. Anthony Mbonye who is also a member of the faculty of public health at London's Royal College of Physicians meaning his ministry endorsed them. As well the assistant commissioner of health services, Dr. Bladinah Nakiganda appended her signature.

Strategically, the revised Guidelines were to be launched on the final day of the Uganda National Family Planning Conference, held from 26th to 27th September 2017 in Kampala.

When they were presented to the state minister for primary health care, Joyce Moriku, there was hesitation and she announced that the speaker of Parliament, Rebbeca Kadaga, was not consulted so she could not launch them.

Ultimately, she refused to launch them saying, Ministry of Health officials had not been consulted and that the Guidelines intended to distribute contraceptives to 10-year-olds.

Birth control is a preventive health care strategy.

In the same breath when the Minister of health, Dr. Jane Ruth Aceng, appeared before parliament she confirmed that her ministry does not own the Guidelines and ‘acting staff’ in this case a high-level well-trained official, who is part of her team, endorsed the guidelines.

The Permanent Secretary at the Ministry of health, Dr. Diana Atwine has also told reporters that they do not agree with the guidelines and they will stick to ‘moral principles’.

Now, besides showing a lame, uncoordinated leadership at Uganda’s Ministry of health this whole fracas shows two other things. While for HIV, the leadership is worried that the money injected into prevention is not yielding matching results and will defend every coin the story is different when it comes to family planning.

This year, the Uganda teen pregnancy rate shot up by 1%. For over 10 years, the Uganda teenage pregnancy levels have stagnated, at least 25 percent of Uganda teenagers become pregnant by 19 years and face four times the risk of maternal death according to the Ministry of Health.

On the other hand, there is increased funding, even domestically, the family planning budget has grown by 40% from $3.3 million $5 million after President Museveni attended the 2012 London Family planning summit. 

But the leaders at the Ministry seem to be comfortable with having more funds and maintaining the miserable reproductive health stats.

Secondly, in February this year, I attended the first international symposium on community health workers held in Kampala. 

The Executive Director for African Centre for Global Health and Social Transformation (ACHEST) Prof. Francis Omaswa, a much-celebrated officer at the Ministry of Health advised that; ‘the best way to manage a system is not to blame an individual. I guess, in this instance, that should be advised to the ministry of health leadership.

This morning civil society had a press conference and confessed to a dangerous trend of Ministry of Health creating a ‘leadership vacuum’ and refusing to provide evidence-based policy and technical guidance on issues that relate to sex and sexuality in Uganda.

They also blamed the ministry for creating a ‘policy desert’ especially for health workers who are faced with challenges of young girls asking for contraceptives.

Apparently, the revised Guidelines are an essential technical tool to equip policymakers and health workers with the framework to provide SRHR services to Ugandans, including adolescent girls and young women.

"We have to address the reality the girls are facing. We need access to services based on science and evidence. Ministry of health should be ashamed," said Moses Mulumba, the team leader at CEHURD.

“Our babies are having babies and it is a reality that young girls are having sex,” said Justine Balya, the Human Rights Awareness and Promotion Forum (HRAPF) Legal Consultant at the civil society press conference.

Civil Society also cited governance issues, saying it is a "failure of leadership on the part of the Ministry of Health," for the launch and later withdrawal of not only these SRHR policy guidelines but also the ‘Standards and Guidelines for reducing Morbidity and Mortality due to unsafe abortion in Uganda’ which were withdrawn in 2016.

For the National Guidelines and Service Standards for Sexual and Reproductive Health and Rights civil society which funded them said all they are interested in is providing age-appropriate family planning information to young girls and that is spelt out in the Guidelines.

Now, no one is interested in giving teens contraceptives. They are too young. But if they become teen mothers their own teen children will also have babies and the cycle will continue.  The best we can do is have an 'open and honest' conversation not mute it. With the right information, they will make the right call! Don't we get it!


Monday, October 2, 2017

Uganda's Biotech Bill Could Become Law Tomorrow?

By Esther Nakkazi

The Uganda biotechnology and biosafety bill is due to be debated in parliament for the nth time tomorrow, Tuesday (3rd, October, 2017).

If it is passed it will send a strong signal to the rest of world if not biotech experts have vowed not to mourn over it but to re-strategise, clean it up and table it before parliament again.

The man in charge is Dr. Elioda Tumwesigye, the minister of Science, Technology and Innovation (STI), a qualified medical doctor who has continuously confessed to not knowing much about agricultural biotech.

Last week, Dr. Tumwesigye was in parliament and while the the bill was on the order paper he deferred to use the opportunity begging to first hear from biotech experts who would be in Uganda attending a three-day (27th-29th September) high-level conference on application of Science, Technology and Innovation (STI) in harnessing Africa’s agricultural transformation.

Tumwesigye himself anxious for the bill to pass was seeking advise on among other things; GMO labelling, strict liability and the expedited review clause, which he has been advised to delete and have stagnated the bill at Parliament.

Experts attending the conference praised Uganda for its progress in conducting field trials but cautioned about it delaying the bill further.

At the conference,  Dr. Tumwesigye reached out to biotech experts for insights into winning over the reluctant Uganda parliamentarians. “For me I am just a medical doctor. I want to understand, if there are now more modern technologies is it still relevant for us to pass this bill,” inquired Dr. Tumwesigye who is also the first minister of the newly created ministry of STI. He was reacting to the statements below.

Answers from the biotech experts were direct and straight. 

“In Africa we like debating as opportunities pass by us. The world has now moved from biotechnology to gene editing. Africans can be leaders and not followers,” said Margaret Karembu, the director of International Service for the Acquisition of Agri-biotech Applications Africa regional office (ISAAA AfriCenter).

“We need to move with some speed so that new emerging technologies do not move ahead of us,” said Abed K. Mathagu the program officer-regulatory affairs at the African Agricultural Technology Foundation (AATF).

To which Dr. Tumwesigye wondered if it was still necessary for Uganda to adopt the biotech bill and not leap frog like Africa did with mobile telephony. “Cant we skip the biotech law and move on to gene editing if the technology is now archaic?”

"Both of these technologies (biotech and gene editing) are necessary and needed. We should not exclude one or another. They both serve different purposes. Before we can have food security people need to be secure about the food they eat," said Kevin M. Folta a professor and chairman of the HorticulturalSciences department at the University of Florida

For now, the Uganda biotech bill drafted in 2012 already has support from the highest office, the Uganda president, Yoweri Museveni, but has failed to get enough support from Parliamentarians for it to be passed.

“I have repeatedly said that there is nothing wrong with this technology. However, there are lots of controversies due to misinformation, which unfortunately seems to have been bought by some legislators,” said Yoweri Museveni.

“My government created the Ministry of Science, Technology and Innovation (MoSTI) in June 2016 to provide a basis for enhancing sector coherence and coordination,” said Uganda’s Yoweri Museveni in a speech read for him by Vincent Ssempijja the Minister of Agriculture, Animal Industry and Fisheries.

Museveni said the priority for the STI ministry is to spearhead the retabling and consideration by Parliament of the bill, which ‘must be adopted for Ugandan farmers to access biotechnology products to increase their production’.

Uganda developed and adopted the biotechnology and biosafety bill 2012, which the Ministry of STI is working towards its enactment into law.

“Uganda should learn from other countries and pass this law now. And it should be done in a way that you do not have to go back to parliamentarians for amendments. The warning is that do not repeat the mistakes of other countries,” said Bongani Maseko, general manager, AfricaBio. 

“If it is passed we are supposed to celebrate. Ultimately, it will send a strong signal to other African countries. But if it does not go through we shall re-strategise but we shall not be mourning,” said Dr. John Komen, Assistant Director and Africa Coordinator, Program for Biosafety Systems (PBS)

Dr. Komen and other biotech experts attending the conference said Uganda’s bigger challenge is actually not just passing the bill but how to operationalise it.

Currently, in sub-Saharan Africa the following countries test GM crops: Burkina Faso, Sudan, Nigeria, Ethiopia, Ghana, Cameroon, Kenya, Uganda, Tanzania, Malawi, Mozambique, Swaziland and South Africa. But only two are currently growing them: Sudan and South Africa.