Refugees a Blessing to Uganda says Museveni

By Esther Nakkazi

Since 17th July 2016, the total number of South Sudanese refugees that have arrived in Uganda is 37,890 according to UNHCR. 73 percent of all refugee new arrivals are children.

Two days ago at the joint political leadership of the NRM that included the central executive committee, cabinet and permanent secretaries President Museveni said Uganda caring for African refugees brought by adversity, is not just charity. It is also good strategy.

He elaborated how the Banyarwanda comrades were supported when they stayed in Uganda as refugees for 34 years (1960-1994). When they gained ascendance in Rwanda, they opened it up for interaction, including trade, with East Africa. Today Uganda exports US$263 million worth of goods and services to Rwanda. Rwanda, in turn, is exporting US$78 million worth of goods to Uganda.

And through Rwanda Airlines, Uganda is currently contributing about US$ 24.1 million to the prosperity of the people of Rwanda. South Sudan, before the outbreak of the conflict in 2013, was contributing US$ 700 million per annum (exports and remittances) to the prosperity of the people of Uganda.

Recently, about 40,000 Ugandans came back from South Sudan on account of the present conflict there. They were there apparently looking for prosperity.

Therefore, Ugandans should know that unity within Uganda and Pan-Africanism in the whole of Africa are not mere acts of solidarity but are also investments to create a better framework for the prosperity of all Africans said Museveni.

“I, therefore, salute Ugandans for welcoming our brothers and sisters, the African refugees as well as other African business persons. It is the cumulative, Pan-Africanist efforts of as many Africans as are enlightened on this point that will guarantee the prosperity of the African people,” he concluded.

Uganda rural based doctors play God

By Esther Nakkazi

Only two years into medical practise, the youthful doctor Gamukama Tuhaise is the in-charge of Rwekubo health centre IV, where a new born baby dies almost every day. With limited resources and a small workforce tough choices make him play God.

On the eve of Uganda's 2016 World Population day celebrations, commemorated world over on the 11th of July, I travelled to Isingiro the land of highland bananas (Matooke) and the venue for Uganda’s big event celebrated and attended by President Museveni and non profits like UNFPA-Uganda.

As the road snaked into the hilly, ridged terrain of Isingiro, you would think all the Matooke eaten in east Africa is grown here as almost the entire vegetation was of Matooke and the many lorries on the road from this Uganda-Tanzania border district were all loaded with them with just a few carrying milk cans.

At least 20 lorries of Matooke leave Isingiro for Kampala everyday and 700,000 litres of milk are produced per month. For the thousands of guests who attended the World Population day  celebrations in Isingiro, refreshments served to us were between a choice of water or milk. I am certain if lunch was served too, it would be a mountain of Matooke on our plates.

The 2016 theme, ‘investing in teenage girls’ was timely and relevant to especially Uganda, which tops the East African region in teenage pregnancy. Everyday over 20, 000 girls under age 18 give birth in developing countries according to UNFPA.

In Uganda, 140 per 1,000 teenage girls get pregnant annually compared to 41, 101 and 128 in Rwanda, Kenya and Tanzania respectively according to UNFPA.

Stillbirths and death in the first week of life are 50 percent higher among babies born to mothers younger than 20 years than among babies born to mothers 20–29 years old, says the WHO.

Furthermore, deaths during the first month of life are 50–100 percent more frequent if the mother is an adolescent versus older, and the younger the mother, the higher the risk.

The rates of preterm birth, low birth weight and asphyxia are higher among the children of adolescents, all of which increase the chance of death and of future health problems for the baby.

The statistics for Isingironian pregnant teens are not available but when I interviewed some of them most were impregnated by fellow teen boys and I am not sure I got an explanation to pin this to. Later when I visited Rwekubo health centre IV and also talked to some teen mothers and their youthful mothers ( now grandmothers) my heart sunk.

A teenage mother with her son Austin in Isingiro district

Seventeen year old Rosemary Kukiriza lay on the bed staring blankly at the ceiling her face showing no particular emotion, not exactly sad, eyes darting from her mother who was standing by her bedside to other teen mothers like her holding their new borns.

She was only 3 hours out of theatre and had lost her first born baby, another statistic at Rwekubo health centre IV where at least a new born dies everyday.

Isingiro has about half a million people. Its located in western Uganda, on the Uganda-Tanzania border, a newly established young district with no referral hospital with Rwekubo health centre IV as one of two biggest and busiest health providers.

Kukiriza’s 36 year old mother was making all the noise, seemingly restless and talking in undertones with an elderly woman attending to a patient on the left bed next to Kukiriza’s. It was her first grandchild afterall who had passed on and she told me she had given birth to Kukiriza at 14 years so why did fate have to follow her daughter and not any other?

She narrated ‘the story’ from when they had arrived at Rwekubo health centre in the night at about 4pm to when they got her daughter in theatre at 10am in the morning, occasionally opening her eyes wide or clasping her hands or slapping one finger into the palm of her left hand to emphasise a point - the whole system was full of delays- she said.

“Why didn’t they take Kukiriza to be operated upon as soon as we arrived? That nurse really delayed. They only took her to the theatre this morning at about 10 o’clock,” she said with near anger or regret in her voice.

Doctor Gamukama dressed in a faded, dark green, cotton health workers uniform and half listening to our conversation explained the circumstances under which Kukiriza had been admitted.

She was in distress, pain and before taking her to theatre certain practical things had to be done; blood type established, vitals taken, the theatre cleaned and prepared, fuel for the generator bought and the lone anaesthetist called in.

The health centre has one oxygen point; no running water - every week a water truck delivers water; it has a few health workers - this happens everywhere as few health workers want to be based in rural areas like Rwekubo health centre IV,  it is powered by a generator-sometimes this jams; and Rwekubo almost serves an entire district of half a million people.

“We have only one anaesthetist will he stay here day and night without doing anything else? Preparation of theatre takes about 40 minutes. The generator has to be fuelled and the theatre powered,” if an operation is to happen said Gamukama.

Kukiriza’s baby was born alive but died a few hours afterwards. It was tired. Efforts to resuscitate it did not help something partly blamed on herbs. “Many women take herbs which thicken the fluids so it becomes difficult when you try to resuscitate the baby,” said Gamukama. Asked which particular herb was responsible for this outcome he said he did not know.

His advise is for women to stop taking herbs when pregnant although in Africa, herbal knowledge for pregnancy is passed on across generations and herbs are preferred to antenatal visits. So outlawed traditional birth attendants still remain women’s preferred choice when giving birth and for nursing pregnancy sickness.

“If you resuscitate a baby for an hour and there is no response you take a decision,” said Gamukama. The oxygen has to be turned off. It is only rational.  It could also be playing God?

He explains; if only there was another doctor-led team in the theatre to handle the baby it would be easier but he has to handle both mother and baby concurrently. Usually, the preference is to save the mother.

Understanding doctor Gamukama’s perspective of the theme in terms of teen mums and saving new borns was real important afterall he is the star of the Isingironian film.

Of the 70 maternal related operations that take place in a month at Rwekubo health centre IV, most of them done by him, 20 percent are of teenage mothers aged 16-19 years and their babies often die. Looking at the centre’s records from 1st July almost a baby had died a day most of them born to teen mums.

“It does not affect them much. After one year they will be back here. They are usually pregnant within the next three months after losing a baby,” said Gamukama with certainty.

Some want to fill the void immediately while others want to stop the scorn and stigma by village communities ‘as the daughter of so and so who has failed to bear a child for our son’.

But there is also prestige in switching names to ‘mama boy’ or whatever name the first born child bears and merely just to prove themselves.

Seventeen year old Ainembabazi Brenda is also camped at the Rwekubo health centre for the last one month and 2 weeks. She has no complications yet in her third trimester of the pregnancy but being a teen and at the advise of the health worker she has stayed.

“When the teen mothers stay here it reduces the risk of losing the baby and it keeps us health workers updated on every step,” said Gamukama. However, its expensive on both the health centre which has limited space and resources and on the family that has to ferry daily meals to the otherwise not sick pregnant woman. Not forgetting the overall confounding factor- poverty.

But its worth it. For instance, in doctor Gamukama’s opinion if Kukiriza had come in at least 24 hours before the onset of her symptoms her baby would be alive. For all those reasons, ‘you cannot stop babies from dying,’ he says. As well, poverty cannot let teen pregnancies stop, he concludes.

As we drive out of Rwekubo health centre's gates, Kukiriza's mother is holding a box wrapped in Africa fabric cloth bearing the body of her grandchild. She waves back to us limply and we wish her well.

Hopefully, her next grandchild born born by teenage Kukiriza will live to see another day and drink of Isingiro's thousands of litres of milk and eat of its mountains of matooke.
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This trip was facilitated by UNFPA-Uganda 

Fun mobile app to dispel sexual and reproductive health myths

By Esther Nakkazi

(Written on July/22nd/2015 and first published here https://www.the-newshub.com/technology/fun-mobile-app-to-dispel-sexual-and-reproductive-health-myths)

A mobile application to dispel sexual and reproductive health myths won the ‘#HackForYouth’ Hackathon organised by the United Nations Population Fund (UNFPA) in Uganda.

The 3G Tree@viQ is an incentive based mobile application, which will provide young people with information about Sexual and Reproductive Health and Rights (SRHR).

It is simple, basic, interactive and fun said Natalie Cojohari, who works with UNFPA in Moldova and was the head of the winning team at the three day Hackathon (22-23 July) held at the Sheraton in Kampala.

The hackathon followed principles of “user-centred design”, actively engaging young people in the development of solutions that are based on their real needs and experiences. It was graced by the Mr. Ahmad Alhendawi, the UN secretary General’s Envoy on youth and Chris Baryomunsi, the Uganda State Minister of Health. It attracted young people from 13 countries.

Although the winning team developed the app for especially the youth in eastern Europe, it can also be adapted elsewhere. The region is burdened by increasing rates of HIV and STIs but is also has a high mobile phone penetration with no sexuality education in school and what is available is not accurate.

Ms. Cojohari explained that there are many sexual and reproductive health myths in her region like; you cannot get pregnant if you have sex for the first time, it is safer to use two condoms, if you wash your genitals with Coca Cola after sex you will not get pregnant.

So the app will basically be a quiz based on myths and if the player wins they will be incentivised with free data, airtime or meal. Ms. Cojohari said it will increase the users self esteem and improve their knowledge on sexual and reproductive health.

At the pitching session, teams came up with innovative solutions which were interactive, informative and educative to youthful users in their privacy customised with appropriate content for particular regions that offer unconventional solutions to promote young people’s knowledge on sexual and reproductive health.

These ranged from apps that could aggregate data, offer vouchers to young pregnant girls to get SRH services, or give youth friendly messages and the ability to chat in privacy with a certified e-volunteer and an app that gives access to information to empower them against sexual harassment.

The judges said the 3G Tree@viQ was well packaged, the quiz gives the youth a challenge and since at that age, everyone wants to beat the system, it will keep them engaged and rewarded at the same time improving their knowledge on sexual and reproductive health and rights in their privacy.

At a time when young people are always looking for data and they want to seek for sexual and reproductive health in comfort and privacy, a mobile health solution is one way to do it. It was a fruitful event and to me all the teams were winners at least in the area of rapid innovations.
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Is Sickle-Cell disorder killing more Uganda infants than HIV annually

By Esther Nakkazi

After Evelyn and her boyfriend had dated for four years they decided to get married. They were young and so in love. The only medical check-up they bothered to take was HIV as was advised by friends and family.

Soon she was pregnant with a baby boy and another one came a year later. Evelyn’s hope was to have two and maybe another set of children later after securing a place in her career as a lawyer.

Henry the second child was sickly and not as strong as his big brother. They blamed it on the diet, the maid, low appetite, everything, whatever. The frequent visits to the hospitals and long nights of the child crying with unexplained pain sent the young parents panicking.

After many misdiagnoses by various physicians, one of them casually suggested a sickle cell disease test. The confirmatory test turned the young family into misery and eventually the husband left to remarry someone ‘normal’ which still leaves tears in Evelyn’s eyes.

Something else still hurts so bad. While seeking treatment for her little boy she was shocked when a doctor said to her “for those who succumb…it is nature’s way of cleansing the human race.” It meant her child would die anyway and it's then that she got determined to fight for him.

About 12,000 to 16,000 children below five years die of sickle cell disease annually in Uganda. Sickle cell disease has been declared a major public health problem for sub-Saharan Africa by the World Health Organization. However, its funding remains very low.

According to Evelyn, ignorance among health professionals and the public is the biggest challenge. “The few doctors who treat sickle cell in children are just passionate about it.”

So while cardiologists are heart specialists and oncologists in cancer, sickle cell disease has no specialty.

Prof. Christopher Ndugwa, a pediatrician is referred to as ‘Uganda's grandfather of sickle cell disease’. He has trained about 80 percent of the doctors who treat sickle cell disease in Uganda.
“I became passionate about sickle cell disease because it was neglected and children were suffering,” said Prof. Ndugwa.

Besides the few medical professionals, the statistics too tell a story of laxity.

At least 15,000 to 20,000 babies are born with sickle cell disease every year in Uganda and 80 percent of them die before their 5th birthday. As a single disease, it could be killing more under-fives than any other although the comparable statistics are scanty.

These figures are from 2014, the Ministry of Health survey carried out to establish the prevalence of sickle cell trait and sickle cell disease across Uganda.

Charles Kiyaga the national sickle cell coordinator at the ministry of health says the survey documented a high sickle cell burden with a national trait average of 13.3 percent and a disease burden of 0.73 percent.

But the distribution is not uniform across the country with some high burden districts; Gulu, Lira, Kitgum, Dokolo, Oyam, Tororo, Jinja, and Kampala have a prevalence of 20 percent and disease burden above 1.5 percent.

With these alarming figures, the ministry of health started newborn screening in the high burden districts covering a total of 274 health facilities and also equipping them with prophylactic drugs like penicillin, antimalarials, folic acid and training health workers in sickle cell management.

So far over 50,000 newborn babies have been tested.

One high burden district though remains an enigma. Bundibugyo situated at the border of Uganda and the Democratic Republic of Congo. It is one of the highest-burden districts with a prevalence of 21.7 percent of trait and 1.9 percent of disease and these figures have been constantly high since 1949.

A 1949 study put the prevalence of trait among people in Bundibugyo at 45 percent. Why its still a mystery is that except for its neighbor Ntoroko district with a trait prevalence of 15 percent all districts around Bundibugyo have a prevalence trait of less than 10 percent.

Scientists believe there is a need to investigate further the factors that predispose the Bamba tribe who predominantly live in Bundibugyo to more sickle cell disease as opposed to the districts around it. Of course intermarriages among carriers without knowledge promotes increased spread amongst communities.

Data from the 2014 survey has been useful as Uganda is now the only African country with current national prevalence data, which has also been published in a leading medical journal, the Lancet.

The research earned Uganda a reward. It was nominated to host the 6th International Symposium on Sickle Cell Disease (REDAC 2016) which happened last month and raised the profile of the disease among Ugandans.

Mass screening, patient management, early testing, counseling, and sensitization campaigns have been created. Pre-marital counseling and testing are being promoted in collaboration with religious leaders.

“We want it to become policy for every couple to test for sickle cell disease before they get married,” says Evelyn.

Dr. Jane Ruth Aceng the Minister of Health says there are plans to scale up newborn screening services in high burden districts and introduce hydroxyurea, which is a disease transforming drug.

She says the Ministry of Health also plans to implement a policy to administer the pneumococcal vaccine to children with sickle cell disease above 2 years to protect them from recurrent infections.

In an effort to increase advocacy and support groups, Evelyn says they have a Whatsapp group and self-help messages.

“We send each other messages if there is a child who is sick or one of our members. We also teach the families to have home remedies,” she says. These could be as simple as using hot water bottles for pain, drinking at least 3-4 liters of water per day, eating nutritious foods.

“If a child eats one egg, a sickle cell child will eat two eats every day. They’ve got to have enough proteins.” In her opinion and considering the pain she concludes, “it is easier to give birth to a child with HIV than one with sickle cell disease.”

NB: Lynn Najjemba a journalist by training has a dear son very ill, a sickle cell sickler who needs to have a bone marrow transplant. For any contributions you can make towards this cause please contact Najjemba directly on  +256704 026 888/ lynn.najjemba@panosea.org or follow the tweet #savekacie

What turns the mighty elephant away? Chilli, Condom, Firecracker

By Esther Nakkazi

A low cost and ingenious innovation made of chilli, a firecracker and a condom can drive a huge elephant away and protect communities' food.

A ‘chili cloud’ made of chili powder mixed with sand and a lit firecracker inside of a condom can be thrown near a grazimg elephant to make it uncomfortable enough to turn around.

This four-step elephant alarm system does not harm the elephant. It just makes the elephant uncomfortable enough to turn around.

Honeyguide Foundation with support from The Nature Conservancy is working with local communities in northern Tanzania to use fireworks, chili powder, and flashlights to safely redirect elephants off farmland.

“The elephant alarm system is an ingenious and inexpensive way to reduce conflicts by safely redirecting the animals off farmland,” said Matthew Brown Africa Region Conservation Director, The Nature Conservancy in a press release.

Before this innovation villagers used to throw a spear at those stubborn elephants and they would go off and die somewhere else but now they use a torch and a chili cloud to chase away them.

Human-wildlife conflict has become a growing challenge as more people turn to farming in corridors where elephants range, conflicts between the two cause huge problems.

When an elephant wanders onto a villager’s farm, it can have a devastating effect: A single elephant can destroy someone’s food supply for the entire year in one night, trample property, and threaten a family’s safety.

“The fact that people on the ground are participating, and we’re saving elephants while protecting livelihoods is amazing. Honeyguide wants to make sure that farmers and communities continue to be conservationists, and in order to achieve this, elephants need to be seen as a friend rather than foe,” said Damian Bell, Executive Director, Honeyguide.

The elephant alarm system does more than protect one wandering elephant and one family’s crops each night: It’s part of a holistic strategy to protect landscapes, natural resources, and wildlife for the long term. Ensuring that local communities benefit from wildlife, and are engaged in their conservation, is a key element to save them.

“Elephants are enormous animals to try and keep out of your vegetable patch and also extremely dangerous animals,” said Bell.

“Since we have developed the human elephant conflict toolkit, we have seen an attitude change with in these communities whereby they are much more confident that they can keep elephants out of their fields without harming the elephants.”

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Using Technology to Increase Family Planning Uptake

By Esther Nakkazi

Often times, leaders and the international community attend global conferences and make commitments towards causes they never honour because there is no mechanisms to make them accountable.

Now Samasha Medical Foundation, a Uganda non profit dedicated to advocating for improved health, has developed an innovation that can monitor if commitments are honoured and translated into implementable activities.

The Motion Tracker is an online monitoring tool that can track mechanisms made towards achievement of commitments made by governments and their leaders.

It is an evidence based tool based on the WHO health systems Framework monitoring service delivery, health workforce, information, medicines, financing and governance.

“This was a proof of concept project translating reproductive health global commitments into action at a country level,” said Moses Muwonge the director Samasha.

“It is an evidence based tool that has been very good for us to know how our resources are expended and has helped us to coordinate with all the stakeholders working on reproductive health issues,” said Dinah Nakiganda, the assistant commissioner reproductive health at the Ministry of Health.

The Government of Uganda made reproductive health related commitments at various global fora; in 2011 at Every Woman Every Child (EWEC), 2012 at the London Family Planning Conference –FP 2020 and in 2013 at the UN Commission on Life Saving Commodities (UNCoLSC).

Samasha working with Reproductive Health Supplies Coalition (RHSC) developed a Commitments Compendium, which has a compilation of explicit and implicit statements from the Commitments made by Uganda, which were deconstructed into implementable activities that can be monitored, said Dr. Muwonge.

In the project methodology, selected individuals from organisations that contribute to reproductive health related commitments were selected basing on a stakeholder mapping matrix.

Primary data was collected using a partner contribution questionnaire and secondary data was collected through review of various documents like policy statements, newspaper articles. Data was also collected from key informant interviews, desk reviews, email correspondences, meetings one-on-one meetings and phone calls.

The methodology and tools have now been adapted by Burkina Faso and Zambia, said Muwonge.

Cornelia Asiimwe the program officer at Samasha says partner reporting on contribution to commitments increased from 23 in September 2015 when the project was launched to 64 in April 2016.

“The percentage of returning users has also grown. At first they were spending just about a minute now they take 3 minutes and more, which shows that they like the tool,” said Asiimwe.

After about a year now, the Motion Tracker has shown that the different commitments are either on track or have been or not achieved in regards to reproductive health commitments in the areas of finance, policy, service delivery, supply chain and technology said Asiimwe.

It also tracks the money and helps policy makers devote money to areas where it is needed most, said Nakiganda.

Espilidon Tumukurate an adviser for Jhpiego, said this is one of the success stories and now the innovation is an export. He however said that Samasha needs to get more funding and take the tool to the lower level- district- and also track how the money is helping deliver services.

More Nurses Needed to Prescribe Morphine

By Esther Nakkazi

Twenty-nine students graduated with a Diploma in Clinical Palliative Care from the Institute of Hospice and Palliative Care in Africa (IHPCA) at Hospice Africa Uganda on Friday 20th May. The graduates who are either registered nurses or clinical officers can legally prescribe oral liquid morphine for pain relief. 

To date the IHPCA has trained 160 palliative care practitioners in prescribing liquid morphine. Whilst palliative care exists in 80% of the districts in Uganda this is “a drop in the ocean” compared with the demand for palliative care in the country.

Uganda is the first country in the world to make legislation that allows trained nurses and clinical officers to prescribe oral liquid morphine, a cornerstone medication used in Palliative Care. This supplements the few number of doctors, who in most countries are the only registered prescribers of such medications.

Dr. Elioda Tumwesigye the Minister of Health said there is an ''urgent need' to scale up and pledged to support the scaling up of palliative care training in Uganda.

“Despite major achievements, especially the work of Hospice Africa Uganda over the last 23 years, a lot more needs to be done to meet all of the palliative care needs in the country,” Dr. Tumwesigye said at the graduation and spoke of his own personal experience with cancer, having lost both parents to the disease. He revealed his mother was on the Hospice Africa Uganda programme in Mbarara.

Dr Eddie Mwebesa, the acting Chief Executive Director of HAU reiterated the huge need for Palliative care in Africa and in Uganda.

Dr. Tumwesigye said he will support to widen the reach of palliative care and to see if the Government, through the Ministry of Health, will consider stepping in to offer scholarships for palliative care courses, or at least to subsidize student fees at Public training Institutions.

He also said he would work to ensure that all the three academic programmes run at the IHPCA - the Bachelor of Science Degree, the Diploma in Palliative Care and the Diploma in Clinical Palliative Care - are included in the Ministry of Public Service scheme of service.

This has been the most serious challenge faced by graduates from these courses because it means they have no channel for promotion or career progression in public service.

Prof. Stanley Acuda Wilson the Institute principal said the IHPCA is playing a vital role in training and educating doctors, nurses and healthcare workers in palliative care in Uganda and Sub Saharan Africa.

The Institute was recognized by the National Council for Higher Education as a tertiary institution in 2009 and granted a provisional license to confer degrees and diplomas in affiliation with Makerere University. It was also granted the degree awarding Institution status in 2014 with a provisional license to award its own degrees and diplomas.

HAU founder Professor Anne Merriman said “despite the achievements by Hospice Africa Uganda in provision of palliative care services with meagre resources, there are a number of challenges which require government help in order to increase accessibility of palliative care in Uganda and fulfill HAU’s vision of palliative care reaching all in need in Uganda and Africa”.

All over the world, including Uganda, the need for palliative care is significant and growing because of the high prevalence of cancer, HIV/AIDS and increasing prevalence of non-communicable diseases.

Hospice Africa Uganda is the country’s pioneer Hospice founded by Prof. Anne Merriman in 1993. According to Worldwide Hospice and Palliative care Alliance in 2016, 40 million people worldwide need palliative care.

18 million die each year in severe pain and distress due to lack of access to palliative care and pain relieving medications. 78% of these live in middle and low income countries and 6% are children. 42% of countries in the world do not have any palliative care services.

Since its inception HAU has cared for over 26 000 people at its three sites in Uganda, (Kampala, Mbarara and Hoima), and it currently cares for over 4,600 patients annually.