Remaining two HIV positive grand children

Flavia Kisembo, 70, is a happy woman today. In 2002, Kisembo was a miserable village grandmother as she considered the future of her remaining two HIV positive grand children. Kisembo had lost three of her children, a son and two daughters to HIV/AIDS. Some of her grandchildren also died from the same disease.

When the second daughter died in 2001, she left three children, two boys and a girl with Kisembo.  “The girl died shortly after the mother’s death. The youngest boy who was about three years was getting sick so often and it was becoming a nightmare to manage his sickness,” Kisembo recollects.

It only dawned on her when one of her neighbours, Rev. Ezra Musobozi who had visited her suggested they take the young boy for an HIV test. It turned out that David Nyakoojo was HIV positive. The elder boy too, was HIV positive.

KIDA comes to the rescue

Rev. Musobozi who is the founder of Kitojo Integrated Development Association (KIDA) offered to take care of the orphaned boys. His organization which had started in 1999 was among its programs running an Orphan and Vulnerable children support program by offering them education and home care, as well as Anti Retroviral medicine to those that had been confirmed to start the life prolonging drugs.

“In July 1998, my wife and I purchased a piece of land in Nyanswiga, a small village located in Ruteete sub-county. The community we came to was as welcoming and friendly as any, but a decade and a half of the AIDS epidemic had devastated the families that lived there.The disease had taken parents away from children, friends away from friends, and husbands and wives away from each other. But more than anything else, it was robbing people of their fundamental right to live,” says Rev. Musobozi. Kisembo was just one of the thousands in Kitojo finding life hard because of the HIV/AIDS effects and poverty.

Kisembo, additionally tussling with old age and a chronic pain in her legs was still worried on how she will manage to continue taking her grandchildren for routine medication to the nearest hospital over 40 kilometers away.

Flavia Kisembo’s hospital dream

“As my life gets weaker, my biggest wish is for a hospital to be built in this area. We need a place nearby where our sick can be examined and admitted. Since many of us have sick people in our homes, it will be easier to take them for treatment if there is a hospital nearby,” Kisembo said in a January 2010 interview. She says she appealed to the Rev. Musobozi to help them get a hospital nearby.

As she stands today among the hundreds of people that turned up for the family health day at KIDA on August 2nd 2011, Kisembo carries a smiley grin of someone whose longtime wish has been answered. At least almost answered!

KIDA’s family health day was organized to launch the services of KIDA Hospital, which though still under construction has been licensed by the Ministry of Health.

KIDA Hospital launches services

“We are going to offer general medical services, including antenatal and delivery, surgical services, immunization, laboratory services, in-patients admissions and outpatients services, as well as improve our HIV/AIDS counseling, care and treatment services,” Rev. Musobozi says.

It is a dream come true for Rev. Ezra himself, who says he has watched many people die or suffer pain due to inability to make it to the nearest hospital, or afford the high fees at those hospitals. It is also a big relief for him, since many people in the community have long thrown their lives into his organisation’s hands, which through its clinic has been offering health care services including ARVs to more than 1,000 people.

He says they are hopeful of getting anti retroviral drugs to supply soon. The satellite center of Virika hospital they were hosting was withdrawn, making it hard for many HIV positive people in Kitojo to access treatment for HIV/AIDS and opportunistic infections.

Counting on the Friends of Ruwenzori

With the help of their funding partners, the California based Friends of Ruwenzori, Rev. Musobozi says they are expecting a consignment of hospital equipment that will make them one of the best health service providers in the region.

A dream come true as KIDA Hospital starts health services

 “In addition to funding our programs, the Friends of Ruwenzori have mobilized the resources to put up these structures, and have secured us medical equipment. We shall have good quality medical beds, surgical equipment, operating and examination tables among other medical equipment,” Rev. Ezra says.

The consignment of medical equipment mobilized through IMEC, another US based non-profit is expected to arrive in Uganda by end of August 2011.

This together with the support that KIDA has started attracting from different circles is giving Rev. Musobozi a lot of hope to deliver the health care that the community expects from KIDA hospital. He says KIDA has recently received delegations and officials from different civil society and government bodies in Uganda inquiring about possible areas of cooperation.

Local leaders impressed with KIDA.The local district government of the area has promised to offer support to the new hospital, starting off with 8 million shillings pledge per quarter to help the hospital in meeting some of the running costs.

The district Chairman of Kabarole, Richard Rwabuhinga who announced the offer while presiding at the KIDA family health day also promised technical support from the district’s health department, as they will be able.

He hailed KIDA for introducing innovative services that are changing the lives of people in Kitojo and neighboring areas of the district.

“A few months back, I was invited to KIDA to celebrate the success of the KIDA SACCO (Savings and Credit Cooperative Association) that was started by HIV positive people to encourage them to save and borrow to undertake income generating activities.

 I’m now here to celebrate with you a family health day that has attracted very many people to receive free medical services at this new hospital,” Rwabuhinga noted.

He said the KIDA health centre, which is now turning into a fully-fledged hospital, is helping the local and central government in providing health services to the people at the grassroots.

The Woman MP of Kabarole district, Victoria Rusoke Businge also speaks highly of KIDA and the new hospital, promising to mobilize any possible support from the central government.

“I’m sure this facility and its unique services is not anywhere in the Ruwenzori region. KIDA is helping the government of Uganda keep people healthy; reduce on material deaths and other challenges. It deserves all the support,” Mrs. Rusoke says.

 An achievement, but a beginning

 Indeed, KIDA does need all the support they can get. The organisation depends on one donor, the Friends of Ruwenzori to fund its programs. The same funders are mobilizing funds for building, equipping, stocking and running the KIDA hospital.

The KIDA facility expected to cost about 2.5 billion Uganda shillings (about US $1 million) is only half way through.

“We are very grateful to the Friends of Ruwenzori for what they have done for our community. We hope there can be others to join hands with them and support us.

We still need funds to build a maternity ward, bigger operating theater, out patient unit, and administration block.

We need to equip the hospital with necessary testing, treatment and care equipment, medicines, as well as pay the health workers,” Rev. Musobozi says.

KIDA has recently been grappling with accommodation challenges for the newly recruited hospital staff.

Being rural based, there are no private rental units anywhere nearby to accommodate the staff. This has forced KIDA to borrow money from its SACCO to build staff quarters.

Rev. Musobozi hopes that the hospital will charge subsidized user fees to enable KIDA meet the remuneration needs of the staff, but raising any income from health services might be real in over a year.

For Flavia Kisembo and many people in Kitojo, these are issues for Rev. Musobozi to worry about. “Our own worry of where to get quality affordable medical care has now been answered by KIDA hospital,” Kisembo says.

End

Cancer patients struggle to survive

Cancer patients struggle to survive

By Hope Mafaranga

In Uganda

Cancer patients struggle to survive the disease and costs, however most cancers can be prevented and even cured if detected early and treatment made available.

But frequent drug stock-outs and an ill-equipped health system mean many patients cannot afford the high cost of treatment, many end up dying. Once a rare disease, cancers of various kinds are emerging to be a big killer in Uganda.

Despite this threat, many of these cancers are either not getting treated or costing huge sums of money.

His breath was slow and desperate, taking every successful breath as if it were his last.

Early this month, Ronald Ahwera joined the agony queue at the Mulago Cancer Institute, the only cancer facility in a country of 34 million people.

Funding to the health sector, most of it from foreign donors, largely goes to three diseases namely HIV/Aids, Tuberculosis and Malaria. So cancer patients like Ahwera are paying a heavy price.

He had arrived here a few days earlier than 4th October when I met him. The 13-year-old was diagnosed with Burkitt ’s lymphoma, a type of cancer common in children.

He has a swollen jawbone, his breath emits a foul odour, blood oozes from his mouth, most of his teeth have fallen out, and he cannot eat food and has to depend on fluids. He is in severe pain.

Treatable cancers

Doctors say although Burkitt ’s lymphoma is highly aggressive and life threatening, it is also one of the more curable forms of cancer. But for patients like Ahwera, the chances of being cured look too distant.

Since arriving at the cancer institute, he has not received treatment. “We have been told that the drugs are over so we have to buy them from the private clinic,” said his sister, Martha Natukunda.

A dose of treatment for Ahwera’s cancer costs 200, 000 Uganda shillings at government rates, but goes for as high as 700, 000 Uganda shilling at the private clinics.

“We can’t raise this kind of money,” said Natukunda. She is still hoping that the hospital can get the drugs so that patients like Ahwera can access them for free.

Hospital officials say although some cancer patients are accessing treatment, many more others like Ahwera are not.

This is because the cancer institute doesn’t have drugs to treat Burkitt’s lymphoma. The drugs are supplied by the National Medical Stores.

Moses Kamabare, the General Manager at National Medical Stores (NMS) confirmed to KC that they have not supplied some of the drugs but said that the various drugs are purchased from different manufacturers.

 “Any one would understand that we don’t buy these drugs from the same manufacturers so they also supply them at different times. We would have loved to have them supplied at the same time but we can’t,” he said.

However  time is already running out and the tumour is growing by the day, spelling more gloom for Ahabwe.

Combination treatment

Dr Jackson Orem, the director of the Mulago Cancer Institute, notes that cancer patients take several medicines, not just one and if the deliveries are made at different times, administering treatment becomes more challenging.

“Drugs are given in combination. So if you are supplying you need to supply a full range of drugs so that they can fit in the combinations that are prescribed,” he says.

“If you supply only one drug then we have to look for two or even more drugs to make a full complement of the combination. The effect is that patients are asked to buy those medicines that are not supplied. If the patients have the money then they buy the drugs. If they don’t have the money, then we are stuck,” he adds.

We can’t treat them without all the drugs because that would be under treatment and we shall only be feeding the cancer,” he notes.

Although a significant proportion of cancers in Uganda can be cured by drugs, surgery, radiotherapy or chemotherapy, especially if they are detected early enough, the grim reality of drug stock-outs and an ill-equipped health system means many patients do not have access to early diagnosis, screening or palliative care - all of which have contributed to the gradual increase of cancer patients and the resultant high cost of treatment.

The story of Ahabwe is a case study of the agony faced by many cancer patients in Uganda -that of how many treatable cancers do not get treated because the drugs are not available in the government facilities forcing patients to shoulder hefty out-of-pocket costs, sometimes millions of shillings per month.

Many patients, especially the poor, have been hit hardest as they are forced to buy the prescribed drugs at a market price, considered too expensive for the average Ugandan.

And for many, at the end of the day, the cost is a deciding factor of whether a patient lives or dies.

Dr Nathan Kenya Mugisha, the acting director of Health services in the Ministry of Health, acknowledges that cancer treatment is prohibitive for many poor patients.

“The problem has generally been that cancer is a very expensive disease to treat. The medicines for cancer are highly specialized so as government we provide what we afford. This explains some drug stock-outs,” he said.

Costly treatment

Dr Orem said most cancers can be prevented and treated if patients turn up earlier and the cost would be relatively low.

Often times though, he said, patients come when the cancers have progressed, making treatment not only difficult but also grossly expensive.

“The cost of treating a patient who has come early is as low as a quarter of treating one with the advanced disease and with a relative amount of money, the chances of cure is high but with a lot of money you have spent, the chances of cure are not there,” said Dr Orem.

According to the medic, treating a cancer patient would cost in excess of two million Uganda shillings for each cycle of treatment, with patients receiving at least six cycles.

Even this is not a guarantee especially for those patients with advanced stage cancer because as Dr Orem explains, by the time the patient has received the six cycles, the cancer will have reduced by just half, meaning a patient needs to be started on another cycle of medication.

But there is a dilemma to this too. Doctors say patients at this stage are less likely to withstand more treatment.

 “So you end up in a situation where you want to treat but the patient can’t tolerate your treatment any longer,” said Dr Orem.

Already overstretched, the Cancer Institute is virtually taking the entire burden of cancer patients as the other government-run hospitals across the country do not have the expertise and infrastructure to handle the patients.

Often times, this leaves the patients with no option but to look towards costly private hospitals or join the long wait at the Institute-sometimes at the cost of their lives. The cancer burden has further been triggered by a shortage of specialists.

There are only five cancer doctors for the 34 million Ugandans, with the institute seeing upwards of 10,000 patients every year.

But having these five doctors, Dr Orem says is a “great” achievement because five years ago, he was the only Oncologist (cancer specialist) in the country.

 “With new cancer patients coming in and old ones coming back, you are looking at about 12,000 cases per year and this year we are projecting it could reach 14,000,” said Dr Orem.

Broken radiotherapy machine

Against the backdrop of rising cancer cases and costly treatment, the country’s only radiotherapy machine is too old and falling apart.

Although crucial in cancer treatment as the radiation rays is what is used to destroy or reduce the growth of cancer cells in the body, the machine has been out of use for the past one month.

Dr Joseph Mugambe, the head of the Radiotherapy department at Mulago Hospital said they had already ordered for spare parts from China and are expecting them to arrive over the next two weeks.

He said the machine which is 15 years old breaks down frequently and will now require replacement.

But as the radiotherapy machine is awaited, and the number of cancer patients keeps growing, health authorities will in the long run be overwhelmed by the numbers and cost of treatment unless huge investments are made in cancer prevention.

End

A study on disasters on crop diversity concluded

A study on disasters on crop diversity concluded

By Hope Mafaranga 20, November 2011

In Uganda

A first study to investigate in detail the effects of disasters on crop diversity and its recovery has been concluded with a combined agronomic observations of looking at the seeds’ colour, size, pattern, and shape with biotechnology tools to determine the seeds’ genetic makeup.

Seeds of local crop varieties must be included in relief-seed packages distributed to small-scale farmers after natural calamities if indigenous agricultural diversity is to rebound faster.

Dr Morag Ferguson, a molecular biologist with IITA and one of the study’s lead researchers, says farmers in Africa traditionally grow many crops and several varieties of each crop on the same plot of land to cope with unforeseen economic or environmental instabilities.

He said that agricultural relief efforts should also capitalize on existing social networks to distribute seeds more effectively and efficiently.

These are among the findings of a recent study looking into the loss and subsequent recovery of cowpea diversity in Mozambique after massive flooding, followed by severe drought, hit most of the country about 11 years ago.

 After natural disasters such as floods and drought that often wipe-out their crops, farmers usually receive relief seed packages to help them recover and restore their food security and source of income.

 However, most of the seeds in these relief packages are generally of introduced and genetically uniform varieties purchased from markets or from seed companies by well-meaning relief agencies, which slow the recovery of crop diversity.

 Interestingly, the study also noted that the speedy recovery of Mozambican cowpea diversity after the double-disasters of 2000 was largely due to the exchange of seeds among farmers through gifting and other social interactions involving friends, family members, and relatives within the same community or adjacent communities.

He said that farmers usually set aside part of their harvest to serve as seed for the next cropping season.

Therefore, when natural disasters strike, many farmers often lose their seeds and are forced to rely on relief, buy from the market, or receive seeds as gifts from friends and relatives.  

“We found that the substantial recovery of cowpea genetic diversity two years after the calamities was mainly due to the informal exchange of seeds among farmers that served as a social-based crop diversity safety backup,” he said.

He addede: “ It is therefore important that seed relief strategies recognize and capitalize on this existing traditional network based on social relations to help restore diversity especially after natural upheavals,” she said. 

The study was initiated in 2002, two years after the flood-drought double disasters and carried out in Chokwe and Xai Xai districts in the Limpompo River Valley –areas that were among those severely affected.

The findings of the research have been published in the current edition of ‘Disaster’, a publication of the Overseas Development Institute (ODI). 

The research established that nearly 90% of the farmers in the affected areas received cowpea relief seed immediately after the back-to-back calamities.

Two years after, only one-fifth of the recipient farmers were still growing the seeds, while more than half sourced their seeds from markets.

However, this did little in restoring cowpea diversity in the affected communities as the seeds bought by farmers from the market were mostly uniform, coming from other districts that grew just one or a few select varieties.

 On the other hand, about one-third of the affected farmers obtained seeds from friends and relatives living within the same or neighbouring localities to restock their farms – the same people that they have been exchanging seeds with prior to the disasters.

 This practice was the main reason why cowpea diversity was restored in these areas, the study showed. 

Dr Ferguson says that such a social relations-based seed distribution system is already in play in an approach developed and implemented by the Catholic Relief Services (CRS) in partnership with other relief agencies in which seed vouchers are exchanged for seed at ‘Seed Fairs.

In this approach, he says farmers from nearby districts not affected by disaster and with excess seed, come to the Seed Fair to sell seed to disaster-affected farmers in exchange for vouchers, which they then cash-in with the relief agency.

  “This approach recognizes that farmer seed systems are robust and resilient, and can provide seed even in emergency situations. And this study shows that such an approach will be more effective in restoring diversity faster and more efficiently than a system based on direct distribution only,” she says.

End

Uganda ranked among the countries with high TB rate

Uganda ranked among the countries with high TB rate

By Hope Mafaranga November 20, 2011

In Kampala

Uganda is ranked the 16th among the 22 high burden countries with 102,000 new cases of Tuberculosis (TB) that occurs in the country every year.

The National Tuberculosis and Leprosy Programmes Manager Dr Francis Adatu disclosed that at the end of 2010, 45,546 TB new cases were identified in Uganda and of these 54 percent were confirmed to be HIV positive.

He added that  330 out of 100,000 people get infected per year in every constituency , adding that  out of 100, 000 people infected by TB, 93 die and the number has been accelerated by HIV/AIDS.

 “TB is the single leading killer of people living with HIV. We must detect, treat and cure TB so that people living with HIV/AIDS can live longer,” he said.

He said that TB affects economically active age group of between 15-55 years which he said has also affected the social and economic development of the country.

 TB is air borne disease that was discovered in 1882 and is caused by a germ known as “Mycobacterium Tuberculosis” and if not treated, TB kills in a period of two years.

Dr Adatu explained that 85 percent of the TB patients suffer from TB of the lungs and 15 percent succumb to TB of the borne.

He said that there is lack of drug adherence in TB patients which has resulted into multi drug resistance that becomes so difficulty and expensive to treat.

He said that 226 patients are on drug waiting list of second line of TB treatment after they developed multi drug resistance while 870 new cases are waiting for drugs per year.

 Dr Adatu was on Friday addressing National TB stakeholders at Grand Imperial Hotel in Kampala organized by Panos Eastern Africa.

Panos is information and communication for development nongovernmental organization that believes that quality information is key to development.

Dr Adatu disclosed that it costs  between US D 200- 300 to treat one ordinary patient of TB, while it costs USD 3000 to treat one TB patient of multi drug resistance.

He said that in order to have a world free of TB, governments must allocate and commit more resources, empower people with TB and the communities to fight and control it.

 He said that the government of Uganda only allocates sh 18m for TB care and treatment which is not enough to cater for the new cases that are raising.

He however said that Uganda’s TB priority now is to halt TB incidence, reduce prevalence rate by 50 percent death by the year 2015 and have the disease eliminated as public health problem by 2050.

He said that there is need to put TB affected people on effective treatment in order to control it.

“Uganda’s priority is effectively control TB control  in order to achieve high cure rate among sputum smear positive cases,” he said.

Dr Adatu urged people to test for TB earlier in so that they can avoid contracting it.

“If you cough for more than two weeks you should go to the hospital test and have the cough investigated so that you avoid to TB,” he added.

He said that there is low community awareness and participation about TB understaffing in the general health sector which he said has affected the performance in TB control.

Peter Okubal the Executive director of Panos said that TB has been ignored yet it has continued to affect the population and claiming the lives of people.

 Cathy Mwesigwa the Deputy New Vision said that despite the availability of a cure for 50 years, 2 million people die from TB every year because  most people do not understand TB and  its consequences and misread the symptoms.

She urged stakeholders to use the media to disseminate information especially where the aim is to effect action, change of policy, or to alter the public's view of the issues of TB.

Mwesigwa said that the media have the platform, audiences necessary to put issues on the public agenda fast, have easy access to leaders and policy makers who can instigate action where other avenues have failed.

End