KAGANDO NEWS
(Past and present - with apologies for delays in updates)
; Correspdence to admin@friendsofkagando.org.ukPage Index
New specialists | Fistula operations | Typhoid | Electricity | Theatre/Maternity extension project | Budget deficit | Containers | Volunteers wanted | Newsletters Page
-
New specialists (top of page)
Dr Asinja Kapuru, Obstetrics and Gynaecology, and Dr Omech Bernard, General Physician, join Dr Robert Olupot the Specialist Surgeon.
Dr Asinja Kapuru (far left)
Dr Omech Bernard (left)
Dr Robert Olupot (right)
Dr Kapuru joined the team on 1st May 2011 as a Consultant in Obstetrics and Gynaecology. He was previously a Senior Special Grade Medical Officer at the Government Hospital at Bwera just 15km away near the border with D R Congo, where he had been since June 2008. His specialist training was at Makerere University, Mulago, Kampala between August 2005 and May 2008. He qualified there and completed one year as an intern in August 2001 before being posted to Bwera as a Medical Officer prior to returning to Mulago for specialist training. He will be taking a significant role in the training of Midwives in the new School of Nursing and Midwifery. He has also been on a training course for fistula surgery and will be joining the fistula surgery team at intermediate level. As a Lukonzo speaker he will be in an excellent position to communicate with the local people and to help plan health education programmes with which they can relate. His appointment has come at an important time now that the Marie Stopes Foundation has provided funding for woman from the area to give birth in Hospital, which has led to a steep rise in the number of Hosptial births. It will now be important to make sure they get the best care possible within the resources available and to continue the drive to reduce maternal and fetal/infant mortality. He also has a Post Graduate diploma in Project Planning. His management skills will be put to the test as Medical Director, suceeding to Dr Baseka Yusuf, who was recently posted to Kasese.
Dr Bernard actually became a Visiting Physician to Kagando in February 2010. He attends every Thursday and Friday and stays in the Guest House. For the rest of the week he is a Lecturer at Kampala International University, Western Campus, with its impressive new buildings in Ishaka near Bushenyi on the road to Mbarara. He was appointed there in December 2009. His visits are greatly appreciated by staff and partly fill a gap caused when Dr George Akol left. He backs up the residents, providing teaching and guidance in mainly adult medicine. He qualified from Makarere in 2000 and gained his M.Med (Internal Medicine) in 2009.
Dr Robert qualified in 1998 from Makerere in Kampala in and M.Med (Surgery) in 2005. He is Deputy Medical Director. He joined Kagando in November 2010. He was previously a Resident at Kumi Mission Hospital in Eastern Uganda in 2000-2, returning after obtaining his specialist qualification as one of their surgeons. Kagando was very fortunate to recruit him from there after the long-serving Dr Frank Asiimwe left to go on his Urology training in Tanzania at the end of 2010. He was already doing some Fistula surgery when at Kumi, including some training with Africa Medical and Research Foundation (AMREF), and has increased his experience substantially while at Kagando. He will be participating, with Dr David Lyth, in the surgical training program run with the College of Surgeons in East, Central and Southern Africa (COSECSA), which has one resident trainee at Kagando currently. He has born the brunt of the responsibility for the increasing frequency of admissions with bowel perforations as a late consequence of untreated typhoid that has been afflicting the hospital increasingly over the last few years. The surgery involved is difficult and in severely ill patients, often children. He is participating in the planning and execution of the multi-targeted initiative against Typhoid that Kagando expects to be leading in the next few months (see below).
-
Fistula operations (top of page)
Operations at Kagando Hospital to cure complete incontinence in women as a result of damage during childbirth, are set to top 400 in 2011. This will be the largest number in any centre in Uganda. Operations are by resident surgeons and visitors. The work is supported by 'Engender Health', a branch of USAid, and Africa Medical and Research Foundation (AMREF). The funding includes patient transfer costs, outreach clinics by specially trained nurses and an education programme.
Drs Robert Olupot and David Lyth are the resident specialists, maintaining a service for cases arriving at the hospital unplanned in the normal course of work. They are joined by visiting specialists, such as Dr Tom Raassen (Nairobi), Dr Judith Goh (Australia) and Dr Weston Khisa (Nairobi) who are support by AMREF. Such fistula 'camps' can last up to two weeks and perform up to 60 operations in that time.
Obstetric fistulae remain a common problem in Uganda and throughout much of Sub-Saharan Africa and parts of Asia and the Far East. The number of surgeons capable of performing these sometimes very difficult operations is growing slowly as are the number of centres willing to host specialist fistula 'camps', particular in Uganda. As with most surgery, experienced surgeons obtain better results overall, particularly for very difficult cases. However an audit of results at Kagando in 2004/5 when there was no resident specialist and no specialised ward resources, showed that medical officers with surgical experience had acceptable results with small and medium sized defects. (Munabi I.G. et al; East and Central African Journal of Surgery Vol.11,1,2006 pp 28-31). This modest success encouraged applications for 'Fistula Centre' status with the previous TB ward converted to a specialised Fistula ward in 2006 and 'Centre' status awarded in 2009*.
*Kagando Hospital in Kasese district is to be transformed into a Fistula
treatment center, according to Richard Nduhura, the state minister for health. http://ugandaradionetwork.com/a/story.php?s=20166#ixzz1Uorw2eXf
-
Typhoid (top of page)
The hospital has been experiencing unprecedented levels of late complications of Typhoid, mainly in the form of life threatening peritonitis follow spontaneous perforation of small intestine. A new Task Force is planning an awareness and prevention campaign. This will link with the Sand Filter project. See the new Typhoid page.
After many years of service, the micro-hydro turbine and generator at Nsenyi has finally ceased working. Several surveys have been conducted and advice sought and a replacement is likely to be the best option. It will have to include replacement of the 4 kilometres of transmission cable. The old underground cable had failed at several points, as a result of excessive demand and overloading causing insulation melting and failure. Now that it no longer carries 11,000 volts if has become the subject of theft. Applications for grants have so far been unsuccessful. It is likely to require up to £200,000.
The hospital now relies on supply from the Kilembe Investment Company Rural Electrification Program , which reached Kagando in 2010, and the new Diesel Generator set donated by Lister-Petter Diesel in the UK. There have been several interruptions sometimes for days at a time in the Kilembe supply. The Diesel Generator (30 KVA - 25kw) is only sufficient for emergency hospital use. The old generator (alos 30 KVA - 25kw) is awaiting long overdue re-furbishment and installation of a new donated alternator. Unfortunately, both the Kilembe supply and the diesel for the generator are very expensive and are significant contributors to the budget deficit.
Diagnostic imaging, (Xray and Ultrasound Scan)
For the first time for a long time, both the Xray and and Ultrasound services are capable of working their full potential. Full use of the Xray facilities is occasionally limited by electricity interruptions in the Kilembe supply and if there are too many appliances in simultaneous use, when on the emergency diesel supply. This can be resolved by limiting simultaneous use of some equipment when on the emergency supply. The 'Diagnostic Imaging Department' now has the potential to collect more in fees than it costs to run and thus help to reduce the budget deficit.
An expansion and refurbishment of the Operating Theatres has been close to the top of the capital requiring hospital development list for some years. Following donations from a private Trust and a Cheltenham Church's Christmas appeal, work has begun on a new theatre, sterile supply department (CSSD), storage and office areas. This will allow non-emergency surgery to continue throughout normal office hours, particularly during visiting specialist surgical 'camps' without interruptions from maternity and general surgery emergencies. It will also allow the old CSSD to be converted into a Labour Ward extension and provide some relief from the overcrowding that has been occurring in that department.
-
Budget Deficit (top of page)
The leaders grapple with a large jump in budget deficit due to Uganda-wide price rises in electricity, fuel, drugs, school fees, salary demands, and un-paid patient fees. There is no reserve fund. Indeed the organisation is having to carry forward a large deficit made up of money owed to a number of creditors who have already extended their support well beyond their original agreements. Delays in making PAYE and National Social Security payments have had to be renegotiated and require regular priority settlement. Although this situation is not unusual in Uganda and particularly in the health sector, it makes the organisation very vulnerable to further financial shocks and the possibility of legal action. Friends of Kagando 'Salary Support' has helped, but is currently well short of the need. KARUDEC is likely to have to make substantial savings from its salary bill in the short-term while planning a recovery strategy. This will be difficult, if not impossible, without external (overseas) aid.
Medical Mission News and its commercial arm 'MMN Containers' has been providing an excellent and very economical service for container transport to Uganda from which Kagando has benefitted in the past. However, changes in Import Duty practice by Uganda Revenue and other considerations has led MMN to decide to withdraw from its Uganda operations. Kagando was also slightly disadvantaged by having to collect their items from Kisiizi, about 120 miles away.
This seems a good opportunity for the Friends to review their arrangements. Containers still represent good value but packaging, loading and preparing inventories and contents lists to satisfy Uganda Revenue is labour intensive.We are looking for a site to store a container while it is being filled. More especially, we are looking for a 'Container Co-ordinator'. This will not be an easy task and may need more than one person. Please contact [admin@friendsofkagando.org.uk] if you think you might be able to help or want more information.
-
Expatriate volunteers needed (top of page)
The KARUDEC leadership have again expressed their appreciation of the work done by volunteers. They benefit particularly from those willing to stay for at least three months and who have skills and experience to offer, especially when in support of a particular project. Almost any role can be considered both medical and non medical. Non-medical roles could include electricians, mechanical engineers, mechanics, plumbers, builders, IT specialists, accountants, store men, hotel management, agriculturalists, teachers, project writers and managers. Medical can include specialists, senior trainees and junior residents, senior nurses, radiographers, pharmacists, physiotherapists, occupational therapists.
Volunteers need to be self-supporting or supported by an overseas based organisation or mission. Accommodation may be provided free or at low cost, but other subsistence and travel costs will need to be born by the volunteer. Approval and terms of service are agreed with the KARUDEC leadership, but anyone interested is welcome to contact Friends of Kagando at admin@friendsofkagando.org.uk . Trustees and others are in close contact and visit Kagando regularly and in a good position to provide liaison and advice. The friends do not at present use their funds to support volunteers directly, but can help with travel and other arrangements and are willing to grant 'volunteer' status to individuals mutually acceptable to both the Friends and the Kagando leadership. See the Visitors page. Speak to a former visitor or volunteer.
