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Uganda, the source of the Nile and the “pearl of Africa” according to Churchill, is a small country in East Africa on the Northern shore of Lake Victoria bordered by the Sudan, Kenya, Rwanda, Tanzania and the Congo. Its independence in 1962 from Britain was ushered in by 2 decades of social strife and civil war and Westerners’ recollections of Idi Amin often loom larger than the nation’s reality of peace and economic growth throughout most of the country over the past 2 decades. Despite being one of the most stable countries in Africa, Uganda remains one of the poorest and most medically underserved countries in the world with very high rates of maternal mortality, malnutrition, AIDS and other health scourges of abject poverty.
DGH has been involved in Southwest Uganda since 1999 when it partnered with the Mbarara University of Science and Technology (MUST), one of only 2 Ugandan medical schools at that time. MUST was dedicated to community medicine and thus a program that initially began with a stream of DGH-affiliated teachers and residents working at MUST itself, evolved in 2005 to a committed partnership with one of MUST’s very understaffed affiliates in the remote Kisoro district. Kisoro is located in the southwest corner of the country bordering the Congo and Rwanda, and is a ruggedly beautiful land of steep hills, towering volcanoes and serpentine lakes. The affiliation between the Kisoro district and DGH soon extended to include the faculty, residents and students of the Albert Einstein College of Medicine (Einstein) in the Bronx, New York. The multi-faceted collaboration has grown significantly through the financial support of the Kisoro District Hospital and Kisoro community from generous private donations to DGH.
The collaboration currently sponsors the following 10 initiatives:
1. Village Health Worker Program: Since 2006, Kisoro/DGH/Einstein trained and have supported 55 Village Health Workers in 45 villages in the Muramba subcounty of Kisoro. The VHWs are active in heath surveillance, education, screening, referral, and identification and treatment of disability, malnutrition and common illnesses. The VHWs are the vital link in all of our community-based initiatives.
2. Kisoro District Hospital Staff: DGH and Einstein coordinate efforts to provide 1-2 volunteer physicians every month to help staff the internal medicine wards of the hospital. Senior medicine residents come from the Montefiore Primary Care/Social Medicine and Categorical Programs, and faculty DGH volunteers from both the Einstein/Montefiore program and elsewhere. A minimum stay of 1 month is expected.
3. Student Program: Both senior and second year medical students from Einstein work with Kisoro/DGH projects in 3 annual rotations in the Fall, Spring and Summer for periods of 2 months or longer. Senior students work in closely supervised teams on the wards for the first month, and in rural villages in the second month, partnered with Village Health Workers (VHWs) doing health screening, community-wide teaching, and home visits. Second year students work on community projects with the VHWs. Although at present (2010), only Einstein students are eligible, plans are underway to incorporate other students into clinical rotations in the near future. Students pay “tuition” to Kisoro (through DGH) that supports their education, mentoring and the projects they’re involved in.
4. Nursing Program: In 2009-2010, nurses have volunteered with DGH to work both on the wards and in the communities, in clinical medicine and public health. Volunteer Nurses have helped establish a Child Disability project, a well-child development and assessment clinic and an educational program on domestic violence.
5. Cervical Cancer Screening Project and the Women’s Clinic: Einstein/DGH volunteers and the Kisoro staff developed the first Cervical Cancer Screening program and Women’s Clinic in rural Uganda, where cervical cancer is the #1 cancer among women. The program, which has both on-site and weekly van-outreach components, has been nationally recognized and its developers honored with the 2010 Lancet-Global Health Education Consortium Community Service Award.
6. Maternal Mortality Project: A new project targeting the high maternal mortality rate in Kisoro has been launched in 2010 with 4 interrelated initiatives. a) Village Health Workers are being trained to identify pregnant women, ensure that they receive appropriate antenatal care, make a delivery plan and assist the woman to implement the delivery plan when in labor; b) a 'first prenatal visit' has been added to the women’s van-outreach services; c) Midwives in Kisoro district, who provide all the non-surgical maternity care, now attend a biannual continuing education conference. The first such conference in July, 2010 was extremely successful--the next conference is in January 2011; d) 'Model' health centers for maternity care are planned in two of the existing health centers to encourage patients to deliver under skilled supervision rather than at home.
7. Malnutrition Program: With the support of the Velaj Foundation and other private donations through DGH, a community-based malnutrition program was initiated in 2008 which feeds an average of 100-150 malnourished children at any one time, and a malnutrition unit in the hospital which feeds approximately 20 extremely sick and malnourished children. The community program is coordinated through local health centers and the VHWs.
8. Chronic Disease Clinic: DGH/Montefiore faculty and residents established the first continuity clinic for chronic disease in the Kisoro district in 2007. Patients enrolled in the clinic are followed for hypertension, diabetes, heart and lung diseases, etc. A medication plan to help subsidize the cost of chronic medication is supported by DGH. In 2011, a community-based initiative to identify and treat chronic disease will be launched through the VHW program.
9. Psychiatry Project: Psychiatric disorders, fueled by social strife and poverty, are a leading source of disability in Africa. Yet, in rural areas there are almost no trained psychiatric health professionals to deal with the tremendous burden of disease. The DGH-Kisoro collaboration has established a Psychiatry Clinic at KDH run by Ugandan staff trained in Psychiatry, a Clinical Officer and a Nurse. Einstein’s Department of Psychiatry provides Psychiatric faculty and residents as DGH volunteers providing care and training 1-3 months/year. On-site consultation is complemented by mobile outreach into the distant rural communities.
10. Disability Project: In 2009 a Child Disability initiative was started by DGH volunteers that resulted in physical therapy facilities at Kisoro District Hospital (KDH), linkages with surgical rehabilitation units in Kampala, and VHWs trained to identify developmental and physical disabilities, refer to physical therapy at KDH, and follow and work with referred children in the villages.