UPCOUNTRY AND BEYOND

I have just returned after a 3 day trip to the upcountry clinics in Gulu and Lira, in the North of Uganda. It was a fantastic experience and I really enjoyed it! The 5 hour road trip up north was quite a challenge as the roads are pretty poor, although much better than they used to be apparently. It takes their toll on the vehicles so every few hundred yards there are cars pulled up having broken down. We passed a lorry whose engine had literally just dropped through the chassis onto the road!! Despite the quality of road and vehicle, people still go as fast as possible so the accidents are all too frequent as well. It was quite horrifying to be overtaken by a bus packed full of people travelling sideways at speed because the chassis was off centre!! Our pickup made it, although it did need new bearings to come back…apparently. It is quite common for requests for new parts to be made, requiring cash that then never materialises into the new part!! However, once we had acclimatised to the travelling, it was possible to enjoy the scenery which was spectacular and involved lots of greenery, colourful birds, baboons, and brightly coloured market stalls lining the roads. We also drove over the Nile which was superb.

We were really warmly welcomed on arrival at each of the clinics and treated to a delicious lunch of local cuisine which usually involved rice and a meat stew! After that, it was straight to work as time was very limited across both clinics. Stephen, the clinic pharmacist was not able to accompany us on this trip, so I did some of the pharmacy auditing at the clinics which was especially important as some of the drugs were going missing. It was an interesting exercise and I was in admiration of the clinical officers and nurses, who are also responsible for costing, dispensing and keeping track of the drugs in addition to treating the patients. Having completed a few checks I then ran a couple of training sessions over the 3 days and was encouraged by how actively and enthusiastically each team member participated. They all seemed to really appreciate the time spent with them. Some of the training was on women’s health, and the management of vaginal discharge and sexually transmitted infections. I had accounted for the fact that the investigations that could be done locally were very limited as there is no facility to culture the swabs, and so concentrated on what was available to process the swabs, such as microscopy and introduced the concept of testing the ph to distinguish the aetiology of the discharge. However, I had not fully appreciated that one of the clinics did not even have any equipment (speculae) to carry out the basic vaginal examinations and had never had access to this, despite also running an HIV clinic!! The beauty of working for a private organisation meant that we could arrange for speculae to be delivered to the clinic on the next trip, and this would benefit all the patients attending, whether they could afford the full price or not. It was an epiphany moment for me, as before coming out here I had reservations about working for a profit/not-for-profit organisation. However, especially in the upcountry clinics, it is clear that money made from those able to pay for their treatment, is fed back to subsidise those that cannot afford to access medical care. It seems the government-run organisations charge a nominal fee so all can be treated but if any investigations or treatment are needed, that requires an additional payment which most people can’t afford, and so their medical care often stops there. Within IMG, for whom I work, all aspects of the care of charity patients, from consultation through laboratory costs to drug costs are paid for through the not-for-profit arm, IMF. Obviously the number of charity patients that can be treated has to be capped but ways of increasing those numbers and extending into the communities to meet those that most need it are continually being looked at and it was great to be a part of that. I visited a school, Lira primary school, which refers a large number of charitable patients to the clinic with malaria, to see if there were ways of reducing those numbers through preventative means. Before visiting we had thought about possibly being able to get hold of some subsidised mosquito nets to distribute amongst the boarding pupils but as you can see from the photos above, even where there were mosquito nets, with the mattresses squeezed in on the floor in that way, they couldn’t be hung properly anyway. We were able to make a few suggestions t o rectify this and also other measures to help, such as reducing the mosquito breeding grounds around the school, and bringing the prep time forward so they were not up so late and exposed to the mosquitoes (all pupils did prep from 8-10pm every night!??) The clinic nurse was going to look at it more closely too. The headteacher said that about 6 pupils a day presented with suspected malaria so hopefully we may be able to impact on those numbers a little.