The Prospective Visitors Page
Share the vision for this beacon in Africa
Provides information and hints on how to achieve a mutually beneficial visit
Page Index:
Introduction | Uganda and the local infrastructure | Who visits and why | Short-term visits - two weeks or less | Visitor etiquette | Surgeons and Doctors | Requests for money | Medium-term visits - three weeks to three months | Medical Students | Long-term visits - four months to three years
Frequently asked questions: Security | Climate | Language | Living conditions for visitors | Dress Code | Money, money transfers and the cash economy | Travel in Uganda | Health precautions | Telecommunications | Learn from an earlier visitor
Visitors - Introduction (top of page)
Until recently the majority of visitors to Kagando and its surrounding villages and region have not been tourists in the usual sense but have travelled to work, to observe, to share expertise, experience and often their faith in an economically deprived part of sub-Saharan Africa. The beauty and variety of the environment is an added bonus. The Guest Houses of Kagando are comfortable, safe, welcoming and not expensive. The staff and families on the Kagando compound are used to visitors, are friendly, polite and not overly curious. The money spent by visitors benefits a community where incomes are low, even for the minority in paid employment, while the majority are dependent on subsistence farming. The challenges of working alongside Ugandan colleagues, within the limited material resources available, offers satisfaction, mutual benefit and a never to be forgotten experience.
However there are rewards for the adventurous tourist. On the equator in the centre of the continent of Africa among the foothills of the 'Mountains of the Moon' with their rarely seen glacial peaks one can see the floor of the Great Western Rift Valley with its huge lakes, channels and gorges. Nearby are volcanic craters, hundreds of species of birds, the chimpanzees in Kyambura or the big game in the Queen Elizabeth National Park. Beautifully located Mweya Lodge is only 30 miles away as a tasteful reminder of international standards if required. The southern routes to the peaks of the Rwenzoris, the largest mountain range in Africa, are unmarked and little explored. The Margherita peak at 5,109 metres on Mount Baker is the third highest in Africa. Myriad footpaths on steep slopes lead between the dwellings of the mountain people, inaccessible to four-wheeled vehicles but occasionally feasible for competent bikers.
Uganda and the local infrastructure (top of page)
Uganda is an economically poor country and the people around Kagando are particularly poor and live a long way from any urban setting. However it has many compensating attributes, particularly the cheerfulness and enthusiasm of its people and some beautiful views with interesting geology, flora and fauna. Electricity and water supplies are better in and around the Hospital than elsewhere, but can still be intermittent, depending on an aging hydroelectric scheme. Uganda mains electricity supply is due to arrive in the valley in 2008, but this also has a low reliability history at the present time. Basic building materials are reasonably accessible, though prices have been rising. There is a limited choice of electrical and plumbing items and these only available in the District Capital, Kasese, 45 km away with the supply and quality inconsistent. This situation applies throughout Uganda outside the capital Kampala, but even there the choice is considerably less than most small towns in the UK and some supplies are very hard to locate. Although 400 kilometres from Kampala, good quality tarmac roads lead to within five kilometres of the hospital.
Community educational levels vary considerably, but only a minority of local people speak good English. Very few have been to University or any other higher training establishment. Kagando Hospital and Rural Development Centre probably represents the most advanced institution in the local area with regard to nationally recognised training and paid employment.
Ugandan education and infrastructure was badly damaged during the time of Idi Amin and Milton Obote II (the second Obote administration). It is recovering, but with a population doubling approximately every 15 years and half of all people in Uganda aged 15 or less, it is an uphill struggle to find and train enough good teachers.
Who visits and why (top of page)
There is no need to characterise typical visitors to Kagando as almost anyone with energy, imagination and goodwill can make a useful contribution while gaining a unique experience. The range is large, from gap-year students seeking work or life experiences, or those at various stages of vocational and other training courses seeking a higher level of responsibility at an early stage in their career, through to short-term specialists and advisors and longer term contracts for those who have completed their training who work alongside their Ugandan colleagues in a sharing or teaching role. In addition, for those with longer life or career experience, it is almost always possible to use or develop an interest which coincides with a local need. There is no better way of acquiring motivation to share in fund-raising activities in the UK than to visit those who will benefit from that effort. Supervised groups of older school children or tourists have not featured much so far, but this is an area that could be developed in the future. As short-term visitors, they cannot expect to integrate much in hospital or education work unless part of a well-planned or on-going project.
Kagando is a community that was founded on Christian faith and values, and these continue to sustain the motivation and commitment of many staff. Qualities of integrity and conscientiousness contribute in large part to the effectiveness of the project. But there are significant challenges, often more sharply defined than in Western nations and there is much mutual encouragement from sharing faith, culture and ideas. Support for Kagando is becoming even more international and there are many insights to be gained from sharing common purposes with other 'expatriate' visitors. Up to the present time the largest proportion of purely financial support has come from Church or Christian related sources. This is beginning to widen, just as many Christians work and operate through mainly secular organisations.
As a courtesy to Ugandan hosts, visitors should be economically independent and self-disciplined and respect local culture and tradition.
If not accompanying someone who has visited Kagando before, the best preparation is to talk to someone who is a regular or recent visitor, indeed many visits follow an enthusiastic endorsement of a visit by a friend, colleague or acquaintance. It will be necessary at some stage to have a named contact or title for someone living in Kagando who will be the main link. After reading the notes below to gain ideas, Friends of Kagando may be able to provide a telephone number or email address of a previous visitor or Kagando resident. Use admin@friendsofkagando.org.uk for your enquiry.
The approximate sequence for any new visitor is: Ideas and proposals; communication with Kagando; identifying to whom accountable; negotiation; financial arrangements; confirming accommodation availability; receiving a formal invitation or acceptance following an application to visit; deciding transport arrangements.
Short-term visits (two weeks or less) (top of page)
Visitors from the UK and other developed nations who wish to engage temporarily in the work of Kagando or contribute to its development might be tempted to think that their privileged access to education, skills training or money will automatically be of some benefit to the community in Kagando. In many cases this is so, particularly if projects they are involved in are chosen with care. Those that provide a needed missing skill or service and enable a local resident to maintain or improve on a new skill when the visitor has returned home are most appreciated. Working alongside as equals is a good way to build up mutual trust. Less obvious, but equally important are projects that improve the infrastructure and have a potential to raise revenue.
These skills do not have to be medical or education related. There is a constant unmet demand for technocrats, artisans and craftsmen of all kinds. Business related professionals can often contribute useful insights. There can be a difficulty over tools and special equipment, which will normally have to be taken by the volunteer if it cannot be established in advance that particular tools will definitely be available. Accompanying visitors, such as wives or husbands, with no defined role are also welcomed and can often find someone to work alongside or to befriend and encourage. Such visitors often see and learn things about the community of which even regular visitors are unaware.
Visitors should not underestimate the benefits to themselves of being obliged to return to fundamental principles as a result of restricted access to materials and services that they have often taken for granted in the developed world. It encourages flexibility and lateral thinking. Achieving good outcomes at substantially reduced cost stimulates fresh ideas on different ways of achieving their goals both in Uganda and in their work at home. In addition to the personal satisfaction of the benefits to the community in Uganda, many also report on how much their visit helped them and influenced their future attitudes and working practices.
The Kagando community is particularly receptive to fellowship on many levels whether or not accompanied by a particular expertise. This may relate to its rural location involving some social and professional isolation. Teaching or leading continuing education groups in the chapel, the schools and in the hospital would be examples. Working under the guidance and direction of the chaplains can be mutually encouraging. Identifying and working with particular minorities, such as those with mental and physical disabilities, in one or more of the already formed groups can be particularly beneficial as they are often marginalised culturally.
Researching viable and feasible projects for fundraising increases the chances of donated money being well spent. Small amounts of money can make a big difference, but care must be taken to provide an adequate realistic budget with continuity and contingencies built in. Sometimes local managers are so keen to see some development that they accept support that is much less than they need for completion of the task, rather than risk losing it altogether. Technological solutions must be appropriate and sustainable. Introducing an expensive technology vulnerable to breakdown can raise expectations and cause frustration and wasted expense unless it can be turned into a value adding initiative in a reasonably short time or show some other benefit. Fundraising organisers are energised when they see the destination for the money and meet some of the people who will benefit.
A potential growth area for which Kagando could become a centre is so-called Eco-Tourism. This is really just tourism and tourist activities with a reminder that developments should be eco-friendly, and set a good example to the community. One example under investigation is providing accommodation of a higher standard than the guest house, but costing much less than an international tourist lodge. The target would be expatriate residents with families for holidays in Uganda or for small conferences or retreats. Another example being considered is mountain biking venture holidays requiring a base in the area.
Visitor etiquette (top of page)
Visitors must remember that they are guests. KARUDEC and other projects in the area belong to the community. Donating time and/or money to projects will give influence and direction but not ownership. Although the local leadership is consistently generous in recognising where support has come from it should be assumed that ownership will revert to them at some time in the future if not from the beginning. A visitor's contribution is never a takeover, but a shared experience. Unless it has been agreed beforehand there should be no net cost to the community from a visit from someone from overseas.
Professional etiquette applies just as much in Uganda as it does in the UK. There is almost always a local person with responsibility for each area of work however tenuously this seems to be exercised. It is essential that the knowledge and approval of such a person is sought in advance of any work done and that a report back to that person should be made at an appropriate time. There have been occasions, not at Kagando, when overseas visiting surgeons, for example, have seen non-emergency patients on a ward and carried out operations when that patient was already in a treatment plan by another local consultant. This is a major breach and can spoil the reputation of overseas visitors as a whole. Assistance by or even teaching a local resident should involve discussion and the approval of their local supervisors.
Visiting Surgeons and Medical Doctors (top of page)
There is also a tradition that visiting surgeons from overseas, for example, should cover the hospital fees for those patients on whom they operate in addition to meeting their own living and transport costs and providing their own services free. They may be able to recover some or all of these from charitable sources abroad by arrangements that they make before their visit. Discussion on expenses resulting from their visit should take place with senior Kagando management and a method of payment and the amount needed to cover these should be agreed.
For doctors working in Kagando, temporary registration with the Medical and Dental Council of Uganda requires a written invitation from the host hospital and clinical accountability will be to the most senior local doctor, the Medical Superintendant usually. Some time should be allowed for the process of obtaining a certificate, which will depend on current possession of its overseas equivalent. Membership of a Defence Society is also required, though UK societies do not usually charge any extra fee for extending cover to Uganda but need to be informed in advance if intending to work. Although Registration is often not insisted upon for a short attachment, lack of it imposes some limits on what can be done, which would be transgressed at some risk, particularly if there were a medical accident or unexpected serious complications in non-urgent case. It would be wise to carry good photocopies of qualifications, diplomas, GMC and medical defence society membership certificates.
The situation is different in an emergency, where even a risky intervention can be justified if it can make a life or death difference. Always discuss with the most senior local trained person, including nurses, about the advisability of proceeding and drug and instrument resources. There are many good texts to guide medical work in low resource situations, which should be read before coming. For example CMF Healthserve (www.healthserve.org and via 'Links' above) who distribute a particularly useful CD with much immediately accessible material and links to other free downloadable resources. There are some text book resources at Kagando, but do not rely on local internet connections. At present these are intermittent and rather slow.
Requests for money by individuals can cause problems and occasional embarrassment and should be treated cautiously and politely. Local people are not slow in coming forward to request funds, usually for school fees or other personal or family requirements. Although there is no need to inhibit giving as a result of such personal approaches on the basis of genuine friendship or the wish to reward an individual, it is wise to seek counsel from local leaders, such as the chaplains or senior staff, in order to gauge the true level of need and avoid subsidising plausible rogues or the already well-off.
Medium-term visits - three weeks to three months (top of page)
Visits longer than two weeks can be for the same reasons as shorter visits, but more usually relate to a planned need for a longer stay either as a repeat visit in support of a particular project or a work or training placement. For example, the University of Leuven in Belgium now sends student nurses for periods of up to four months. After an induction period with the trainer from Belgium present, they are left to continue to work alongside their Ugandan nurse colleagues and students. A recent visit from several students from different disciplines organised by Oxford University Inter-Collegiate Christian Union participated in a number of previously planned projects.
Medical Students (top of page)
Medical students on their 'elective' are probably the most frequent type of visitor staying more than two weeks and are good example of those who can both contribute to and gain from their time in Kagando. Most are near the end of their training and usually work in the hospital as the equivalent of doctors who have just finished their training. This relieves some of the pressure on the resident doctors and nurses and is an early chance to gain practical experience as the first person to examine and treat a patient. Experienced doctors are nearby to introduce them to local practices and advise or take over as appropriate. For those with no earlier experience of Africa, about one week is required for orientation. A stay beyond two weeks brings rapidly expanding benefits to both the student and the hospital and a chance to get to know the community. Ugandan medical students are also frequent visitors and with increasing numbers from Europe and North America it becomes a congenial international shared experience.
Try Google with 'Medical Elective Kagando Uganda' for further information. Much of such information goes out of date quickly, such as 'security problems' (there have been none for several years) and 'no telephone' (there is a telephone network mast in the hospital grounds and the mobile network works very well).
Students are usually accommodated in 'Clay House' where some of the resident doctors also stay. This is closer to the hospital than the Guest House and has its own team of staff for catering and other domestic arrangements. See also the Health Precautions section.
Elective medical student placements at Kagando are oversubscribed and not all applications are accepted. It has also led on occasions to excess numbers on site at the same time. Applications should be to the Medical Superintendent, Kagando Hospital, Private Bag, Kasese, who allocates responsibilities for doctors within the hospital and will assign students to particular areas avoiding duplications and overlaps and rotating when necessary. It is helpful if students indicate preferences such as surgery, medicine, paediatrics, maternity, community etc. and if they would like to work in a pair with anther named student. If acute clinical ward allocations are oversubscribed then it is a good idea to request opportunities outside the hospital in community or Public Health teams including Tuberculosis, Leprosy, HIV/AIDS and Palliative Care. There is an increasingly close liaison with the nearest Government Hospital on the Congo border at Bwera and a placement there, either by visiting daily or staying there would provide a valuable parallel opportunity, but students should not stray too far away from access to local residents to advise them and might need a budget for local transport. The Medical Superintendent is very busy and should not be approached to sort out problems unless they cannot be resolved by direct negotiation with those involved. He will often be happy to agree changes made after discussion with fellow students following arrival.
Long-term visits - four months to three years (top of page)
The Kagando management are keen to encourage long-term volunteers in almost any area of work within the hospital. Posts of longer than one year have usually been supported by particular international mission and other organisations who pay their volunteer's salary and other costs, but individuals willing to meet their own costs and work in an honorary (unpaid) capacity are also accepted. In recent years such posts have included doctors, a pharmacist and a theatre nurse from the German Medical Mission Team (GMMT), a nursing sister in charge of the paediatric ward from Church Mission Society (CMS), Tutors in the nursing school and Physiotherapists from Africa Inland Mission (AIM).
Frequently asked questions (top of page)
Security (top of page)
The most recent security problem to affect Kagando was an incursion by Ugandan rebels from Congo in the 1990s which lasted six weeks. The closest that the problems in the north of Uganda reached to Kagando was about 60 km several years ago. There has been no awareness of a significant security threat since the year 2000 and little visible security presence. The UK Foreign Office Website should be checked, but this has usually appeared unduly pessimistic to recent visitors and mainly refers to problems a long way from Kagando.
There was an outbreak of Ebola virus north of Fort Portal (100km) in November 2007 and Kagando was on standby to accept cases. The risk of an expatriate actually catching the virus must be extremely low, but mortality is in the order of 50%, so the fear is real. The main problem an outbreak causes is that all movement within a wide radius is frozen until three weeks after the last case is confirmed. No one is allowed into or out of the area for any reason, particularly flights home.
Climate (top of page)
Uganda is mostly greater than 1000 metres above sea level, with high rainfall and humidity. Twenty-five percent of the area within its boundaries is covered by water. The Guest House at Kagando is 1185 Metres above sea level at 0o 03' 40" N 29o 53' 59" E. The 'Google Earth' view is rather low resolution currently, but the roads can be seen. The seasons in Kagando have been difficult to distinguish recently, but in general it rains more between October and December and from April to June. Temperatures are rarely much below 20oC or above 30oC. Some days can be completely overcast with poor visability but the sun is often seen on the same day as rain, which often seems to last a few hours at most and the ground generally dries quickly. There are of course exceptions and there were severe floods in many areas in 2007, but not around Kagando. Average humidity is on the high side and the top of the Rwenzoris are frequently in cloud.
Insects are not a particular problem except sometimes after rain. They can usually be kept out of rooms, which are easily cleaned.
Language (top of page)
The local language is LUKONZO, which is spoken by about five million people most of whom live in Congo. Some patients and staff speak Swahili but this is spoken less in Uganda than in the neighbouring countries of Tanzania, Kenya and Congo. French is spoken in Congo, Rwanda and Burundi. English is the official language of Uganda although there are moves to substitute Swahili, as in Kenya and Tanzania. There are several members of staff in Kagando who are proficient in many local languages. The chaplains are in a good position to advise you if you need a translator outside the hospital.
Apart from English, the most spoken Uganda language is Luganda, spoken by the Baganda peoples who live mainly around Kampala. English is the language of school, higher education and administration.
Living conditions for visitors (top of page)
The Guest House has a normal mains water supply and preferential access to electricity (240V AC, 50 Hz with UK style 13 amp plugs). Lavatories in the guest house are all flushing, although the seat is somewhat low by UK standards. There are some lavatories for staff in the hospital, which you will need to ask for. There is no hot water supply and no baths, but several shower cubicles. In the new Guest House Extension, lavatories and showers are 'en suite', and consequently a little more expensive. It is easy to maintain health and hygiene standards. A 'solar shower bag' left outside during the day will provide at least one warm shower in the evening.
Food provided by the Guest House and Clay House staff is acceptable and nutritious. Menus are rarely supplied, but they will often know on the day and are amenable to suggestions. Excellent fruit is available, though partially seasonal. Meat is mainly goat or chicken, with occasional pork as a luxury. Fish, almost always 'Lake Talapia', is available. Vegetable varieties are similar to Europe with the addition of Millet and Maize. Baked or boiled green banana is the national dish of Uganda, known as 'Matoke', but normal tasting small yellow 'eating' bananas are also available.
There is a 'no smoking, no alcohol' rule within the hospital and staff compound. This is a reflection of the mission origins and disciplined Christian lifestyle that is a large part of the success of KARUDEC as an institution. Chapel starts promptly at 8.00 am on every day except Saturday. Attendance is not compulsory although it falls within the shift times for most staff to enable them to attend and is the main means of communication on events happening within KARUDEC.
Dress code? (top of page)
There is no formal dress code for visitors or locals, apart from nurses whose uniforms are kept in remarkably clean condition in the circumstances. Extremes of dress will cause puzzlement at least and in some cases offence. For women it is better to avoid too much 'bare flesh'. Knee or below knee length skirts or dresses are common, although traditional local dress, the 'Kinza', is down to ankles. Trousers for women are acceptable in expatriates, but tight fitting may cause unwanted attention and difficulty for the local leadership, who may feel obliged to comment and it might inhibit a good relationship with them. Comfort and lightness with a degree of 'smartness' when working is best . Local people like formal dress for formal occasions, but suits or jackets are rarely worn by short-term visitors, though a tie might make a suitable statement. Hats are only required against the 'midday sun', to avoid sun damage. Sun-screen is advisable if spending much time out in the open, though the intensity is generally less than in some parts of Africa. Sandals are popular, but offer little protection from dust, insects and injuries. The Clay House and Guest House staff will do laundry for a modest fee but, as elsewhere in Uganda, should be asked if they are willing to wash underwear.
Money, money transfers and the cash economy (top of page)
Most of Uganda operates on a cash economy. Only a small minority of Ugandans have private bank accounts and there are few banks outside towns smaller than the District capitals. Travellers cheques can be difficult to cash and transaction fees can be quite high. Dollars (USD) are easiest to exchange, and it is worth keeping some for emergency use. Goods and services for tourists are often priced in USD. Exchange rates for UK Pounds (GBP) are fair, particularly in Kampala in Forex Bureaus and the Post Office and exchanging GBP avoids a percentage loss when using them to buy dollars in the UK before travelling. Euros are also widely accepted. The current exchange rate (August 2008) is around 3,200/- UGS per £1.00 GBP. Three hundred pounds will make you a UGS millionaire!
Visitors are recommended to bring sufficient cash in large denomination notes and exchange enough for their stay into Uganda Shillings in Kampala as soon as possible after arrival. Notes should be clean and without writing on them or torn edges as some Bureaus will refuse to accept defaced or old looking notes. Credit cards can only be used in larger international hotels and lodges and may attract an unfavourable exchange rate or transaction fee. Cash is becoming more frequently obtainable from machines accepting international credit and debit cards, including in Kasese, where it can otherwise take about an hour to reach the head of the queue.
KARUDEC has a bank account in Kasese and it is possible to arrange transfers to this by private e-banking methods. This can be useful for paying bills incurred while at Kagando. If the expense has a charitable purpose, such as paying patient fees, then it may be possible to arrange transfer to the KARUDEC account from a charitable account to which a gift-aid refund has been or will be added. 'Friends of Kagando' can arrange this with adequate notice, prior agreement as to its purpose and an adequate donation to cover the expense.
Normal travelling precautions should be observed in Uganda, such as not keeping all money and valuable documents together, maintaining a separate record of key telephone numbers, passport numbers and other key information, and never allowing valuables to be conspicuous.
Travel in Uganda (top of page)
Road travel (the railways do not carry passengers) can be the most exciting and sometimes the most difficult part about time in Uganda and much will depend on the visitors budget. Buses are cheapest but require some rapidly acquired local knowledge to know where to catch them, how to know where they are going and what standard of comfort they provide. Some express coaches, for example, guarantee a seat and have an on-board lavatory, but are more expensive. Back-packer's hostels and expatriate meeting places in Kampala and elsewhere are a good source of information.
For travel over short distances, particularly around town, the Boda-Boda should not be dismissed. The name arises from their role during Uganda's past troubles when motor bikes and bicycles were commonly used for smuggling back and forth across the 'border'. Motor cycles have obvious dangers, particularly without crash helmets, but they are often skilfully ridden and can be asked to slow down. They are cheap, and a price can often be negotiated. They are everywhere where people congregate. Pick one out from a distance and try to get away quickly before you are mobbed with alternative offers.
Taxis can be public or private. Public Taxis are usually blue and white chequered Combi-like people carriers. They have 'conductors' who hang out of a window waving an arm looking for customers and shouting their destination. The will often not leave until they are full, or overfull. They can be found in town centre locations and near groups of shops. They are reasonably economical and good for use at short notice, though standards of upkeep vary and they tend to travel as fast as they can be made to go. Private taxis also vary in quality. They are usually saloon cars with a single driver and a fair should be agreed before you accept a ride. They are often willing to travel long distances, all the way to Kagando, for example, for a not unreasonable fair. Best of all is a recommended private taxi. Kagando is 400 km from Kampala and it takes about seven hours to drive there. A private taxi will charge around the equivalent of £100 GBP for this, though prices are probably rising with fuel price rises.
Yasin Koire provides a very reliable taxi service. If he cannot help you himself he will find someone who can. You can email him on yasinkoire@gmail.com or text/speak to him on +256(0)7724 34708. [omit 0 (in brackets) if phoning from abroad. Include 0, and omit +256, if phoning within Uganda. Be cautious about phoning people in Uganda from outside Ugando. Some mobile phone providers will charge for RECEIVING calls from abroad!
Vehicle hire can be difficult and/or very expensive. It is not recommended that newcomers should drive themselves, though this is perfectly safe after a bit of orientation and experience. A UK driving licence is accepted. The larger car hire companies will often insist that you take one of their drivers, particularly for large 4x4 vehicles. Four wheel drive is not essential in Uganda, but an advantage if you might need to travel off-road at times. Hire costs are much less for driving within Kampala city limits, but for elsewhere are rarely less than $100 USD per day, and often more.
It is sometimes possible to hire a car privately from a Uganda resident. It is a good idea to consider engaging a driver as well, which can cost less than $15 USD per day including subsistence if an overnight stay is required. Breaking down a long way from Kampala on a lonely stretch of road can be a harrowing experience without local knowledge and at least some local language skills.
Finally, for the very well-off, a light aeroplane can be chartered from Entebbe airport. There is an airfield at Kasese, which is 45 km from Kagando.
Health precautions (top of page)
Many common tropical diseases are endemic in Uganda and in the area around Kagando, though that does not mean that they are seen frequently in visitors. Visitors should try to follow general guidelines for the preservation of health in tropical climates as the best means of prevention. Doctors should be informed of a visit to Uganda if becoming ill for any reason on return to the UK. Yellow Fever is the only compulsory vaccination required, and opinions should be sought about other travellers vaccines for which no clear advice is emerging. Gastro-intestinal disorders are best prevented by only drinking water that is known to be treated, boiled, filtered for micro-organisms or sold commercially for drinking (bottled water, Coca Cola etc.) and eating food that is likely to have been adequately and reputably prepared. It is probably safe to drink water from the tap in Kagando, but it is better to develop a habit of not doing so as accidental contamination may not be reported immediately and supplies in other parts of Uganda may not be so reliable. Skin injuries should have antiseptics applied quickly and they should be covered with a dressing. Basic hygiene, including daily showers, is good practice and probably preventative. There is a high prevalence of sexually transmitted diseases, including HIV, among the more promiscuous parts of the community, though STDs can be innocently acquired by some faithful men and women from unfaithful partners.
Medical students and others who might come into direct contact with infected bodily fluids in a medical accident will have been vaccinated against Hepatitis B as part of their conditions of work in the UK. As the prevalence of HIV in hospital inpatients is in the order of 25%, they should practice aseptic technique as if all patients are HIV positive and be appropriately attired with aprons, gowns, boots, eye protection and double gloves if assisting at surgical procedures, and follow local advice on decontamination assiduously. In the event of a possible blood contact with HIV infected fluid as a result of a needle or scalpel injury, they should start anti-retrovirals within one hour. Most medical school student health services will provide a few days of these, or advise on how to obtain them and they are available in Kagando if required. They should have an immediate test to confirm their own negative HIV status and a repeat test around three months later to confirm that they remain sero-negative. Similar advice should be considered if injured in a road accident.
If a visitor expects to come into regular contact with patients and will be expected to help with practical problems, it would be wise to take a box or two of 100 latex examination gloves that can be purchased from most pharmacies for about £7.00 per box. These are normally in good supply at Kagando, but there has been a national shortage in Uganda recently (November 2008). Leave them behind for the wards or recently arrived visitors. A supply of germicidal soap for use on the wards may also be advisable as this is not always available at hand washing sinks.
The commonest disease of all is Malaria, almost always of the Falciparum variety and is exclusively contracted from infected mosquitoes. Although recurrence of the Falciparum variety can only occur from re-infection, it is the most dangerous form in terms of risk to life and it is recommended in the strongest terms that visitors should take appropriate prophylaxis before, during and after their visit to Uganda.
There are many agencies that can advise on malaria prophylaxis. The two commonest drugs used are daily DOXYCYCLINE, and MALARONE. MALARONE is expensive, but well tolerated and effective in higher doses for treatment if required. DOXYCYCLINE is effective, but causes indigestion like symptoms and sensitivity to light in some individuals. Gastric and oesophageal symptoms can be avoided by taking DOXYCYCLINE with food and washing it down with a drink if taken after food to avoid the tablet or capsule coming into direct contact with the mucosal surface of stomach or oesophagus. If taking DOXYCYCLINE as prophylaxis, a treatment course of MALARONE should still be carried and taken if Malaria is suspected. DOXYCYCLINE is also used in the treatment of several tropical infections, but its role in the possible prevention of these would not be a reason for taking it if it were not also effective against malaria.
There is a problem throughout the whole of the developing world of counterfeit drugs. Kagando buys from reputable suppliers though at the lowest possible cost. There is no evidence that it has been victim of this phenomenon, but it could take some time to reveal itself and there is no easy way of checking. It is wise to bring a personal supply from the UK of drugs you are most likely to require, particularly if you are medical yourself and may need to help a companion. Most such supplies remain untouched and can be given to a Ugandan resident or incoming visitor before leaving.
It should be remembered that the commonest cause of death in a white person in Africa is a Road Traffic Accident. These are still rare, but are reason to avoid risky situations unless there is no alternative or choice in the matter.
Medical evacuation by air (Medivac) within East Africa is very expensive and a flight back to the UK with a medical attendant even more so. Serious cases are taken to Nairobi or South Africa. Check whether your travel insurance covers this or be willing to pay up if necessary. Google 'Medical Air Evacuation Uganda' for up-to-date information.
The organisation 'Interhealth', with a base in the UK is well placed to provide up to date advice and offers a pre-visit advice and screening service.
Telecommunications (top of page)
One high quality service that is available almost all the time and almost everywhere is a mobile telephone signal. Kagando hospital is host to a large steel MTN telephone mast on the hill east of the Hospital. MTN is one of the Ugandan mobile network operators and is a popular choice. Scratch-card airtime can be bought in the Hospital shop and Pay-As-You-Go SIM cards are readily available for 5,000/- UGS (about £1.50 GBP). These have the advantage of providing a Ugandan telephone number, which not only reduces the cost of the calls, but avoids the need to distribute one's private international telephone number too widely. UK phones will work, with international use agreed with the network provider before leaving the UK, but this will cost more - about £1 per minute and £0.40 for a text message.
The international prefix for Uganda is 256. For calls from most phones this will therefore be +256...followed by the number from the number you are calling but omitting the first 0, if there is one. On other phones you may have to dial 00 before the 256. Be wary of calling Uganda numbers from outside Uganda as some mobile operators charge users for receiving calls from abroad.
There is limited access to the internet available in Kagando from a few computers in the administration block or by WiFi from a laptop used close to the administration block. It is slow, but satisfactory for webmail and limited web surfing if the sites reached are not too sophisticated. The hospital makes no charge for this access currently. GPRS capable mobile phones can be connected directly to a laptop, but they are very slow for those used to broadband and half an hour online could cost £10 GBP. At the time of writing (November 2008) the satellite communication is not working.
MTN now market a USB connected small GPRS/EDGE modem for 330,000/- UGS (about £110 GBP) and there is a tariff for unlimited access that costs 90,000/- UGS (about £30 GBP) per month. This is a bit slow, but it can be used from anywhere on the hospital site and in the residences - in fact anywhere in Uganda where there is a good signal. If you buy one, you will probably be able to sell it on when you leave. These can be bought from MTN Head Quarters in Kampala from an office opposite the entrance to Garden City Shopping Centre, and possibly other MTN centres if you enquire first [www.mtn.co.ug]. It may be possible to do what the modem does via any GPRS enabled phone, but the modem is certainly easy to set up as all the software is 'plug and play'.
Learn from an earlier visitor (top of page)
Many mistakes and wasted time can be avoided by speaking to a previous visitor who can brief you better than any document and save you from unnecessary anxieties and re-inventing too many wheels. Of course they will all tend to speak from their own perspective, so in the end there is no substitute for getting out there to find out for oneself. The better prepared are more likely to enjoy the experience and 'Friends of Kagando' aim to facilitate this as much as possible. Enquire via admin@friendsofkagando.org.uk.
