A Month in the Life of a Rural Hospital

Article from the series: Staying Safe and Healthy in Rwanda, Uganda and DR Congo

After we covered the tourism aspects of Kisiizi Falls and discussed staying healthy in general, allow me to give you some practical examples of how we provide health care in upcountry Uganda. Today’s article is based on a richly illustrated newsletter we send out every month or so, and if you wish to get future updates please drop us a line on khmedsup@gmail.com.

Described by a visiting specialist doctor as “an oasis of first-class medical care,” Kisiizi Hospital has a particular focus on caring for the vulnerable. For example, we are running the oldest community health insurance program in Uganda with over 40,000 beneficiaries. They pay premiums of only around 15,000 Ugandan shillings (USD 4) per person per year for acute medical and dental cover.

The fountain in the image above is situated in the middle of the roundabout in our in-patient zone, with the original flax factory building shown in the background. It was put in around 1992 with a simple gravity feed, and it has provided entertainment for many children and visitors — as well as home for quite a few fish!

The water keeps on flowing and so, somehow, does Kisiizi in spite of all the challenges. In September 2021 the pandemic lockdown was still tight and had a big impact in many ways but we are making significant progress.

History is made! For the first time ever, Kisiizi Hospital has some piped oxygen to supplement its existing concentrators and cylinders. The Fre02 foundation supplied us a system that utilises two oxygen concentrators with a reserve cylinder to provide piped oxygen to five beds in our Children’s Ward. With the current Covid-related pressure on oxygen supplies, we are so grateful for this extra help! The most common reason for admission to the Paediatric Ward is respiratory illnesses such as bronchiolitis or pneumonia and oxygen may be lifesaving.

Ruth Sloman, a volunteer midwife in Kisiizi some years ago, is now working in Burundi. She shared our formula to prepare alcohol-based hand rub with the World Health Organisation. The photo shows the Burundian technicians now preparing their own hand rub on site.

Recently it was our time of stocktaking and checks in many departments — even livestock! Kisiizi has chickens, goats, cows but we don’t count the fish or the bees!

Dr Doreen Asunye, Medical Officer, and Mr Charles Tumwijukye, Clinical Officer, have just joined us. Doreen was previously an Intern Doctor in Kisiizi. Charles had done a clinical attachment before working in our sister hospital next to Bwindi Impenetrable National Park. After his orientation at Kisiizi, Charles moved to the village of Rwentobo where he heads our satellite establishment, the Hope Community Clinic.

These are sacks of “posho” which is maize flour (a bit like “Ready Brek” in UK) and one of the staple foods in our area. We were able to provide 10 kg to each member of our staff to support them in the challenges of the lockdown.
Thanks to the generous support of our donor organisation Kisiizi Partners, we were able to restore salaries back to 100%. The Covid situation has led to a fall in patient numbers and that has reduced hospital income.

When news got out that some Covid vaccines had been brought, people quickly started arriving. The supplies were limited, so we tried to prioritise health workers in the front line and the more vulnerable. Many of our staff are now protected but in the wider community most have not yet had the vaccine.

Patients who need high flow oxygen require support from cylinders (our concentrators can only provide 5–6 litres per minute maximum of around 92% oxygen) but refilling is challenging. We currently have to drive to Kampala 7 hours away and pay 50,000 Ugandan shillings per cylinder to fill them (about USD 14). For comparison, a labourer in our area earns about 7,000 shillings a day when work is available …

This little girl was born at 25 weeks gestation (15 weeks early) in Nyakibale Hospital near Rukungiri weighing 900 grams. She was referred to the regional referral hospital in Mbarara but the parents decided to bring her to Kisiizi. She was managed with oxygen from a concentrator, intravenous fluids, aminophylline (a medicine to help breathing) and antibiotics. She developed significant jaundice requiring phototherapy (this prevents deafness and brain damage that can occur with high bilirubin levels). She established feeding and later needed two top-up blood transfusions when she became anaemic, and a further course of antibiotics and oxygen when she developed sepsis. She received “kangaroo mother care” where she was carried on mother’s chest with skin-to-skin contact to keep her warm and encourage bonding and feeding. On Day 43, the baby graduated from the incubator to the baby cot. On Day 61 she was 1.86 kg and ready to go home, much to the delight of her parents!

After previous postponements, the Kisiizi School of Nursing & Midwifery went ahead with its graduation. It was a virtual one — it was televised to allow graduates, their families and others to watch from their homes. A limited number of representatives were present in a couple of marquees on the playing fields of the Kisiizi Hospital Primary School.

Kisiizi is very happy to have the St John family back again as volunteers! Let’s pass the microphone to the parents …

Heather: “Together with my husband and three kids we moved to Kisiizi in January 2021. My mornings are spent home-schooling my eldest two, and I devote some of my other time to setting up a reusable pad project. Last time I was here I did some art classes in primary schools and noticed that girls were dropping out of school due (in part) to the expense of period products. I did some research and they informed me that in areas of Uganda where pads are given out for free the rates of sexually transmitted infections reduce. They discovered that men were offering to buy girls pads in exchange for sex! This made me so furious that I started the process of researching good washable pads and experimenting with different designs whilst praying about what to do. I’ve had help from a wonderful local teacher and social worker and together we did a small pilot. I made some different pads and gave them out to a group of ladies who gave feedback and helped hone the final design. A tailor worked with me to make our first batch
of 500 washable pads and waterproof bags.”

Barak: “I completed my specialist GP training in 2020 and became a doctor to work with the needy and vulnerable. I have always felt a strong calling to work in resource-poor countries and am honoured to be serving in Kisiizi. I supervise and teach three medical interns and really enjoy working with these young and keen doctors.“

We have recently had a BBC film team here focusing on our hydroelectricity project and looking at how the power is used in the hospital. The program will air on the BBC Africa Smart Tech series.

We are very grateful to Lions Clubs International Foundation and local members for the donation of some very important ophthalmology equipment.

The rainy season is coming but we pray for strength as we move forward.

For more information please see the Church of Uganda — Kisiizi Hospital website.