KIHEFO (Kigezi Healthcare Foundation) is providing health care to not only the urban residents of Kabale but also to people in the outlying villages. In many of these remote, rural areas someone might go months or more than a year without seeing a healthcare provider, due to the cost of seeing a doctor and the distance of travel.
In Uganda, health care covers a range of services. There are the Village Health Teams at the very bottom of the health pyramid; they do some public health services and coordinate with others if needed. Higher up, there are the Health Center II’s, III’s (might have beds), and IV’s which offer a wider range of services. And at the very top, there are the private and government hospitals, where doctors midwives, and all sorts of services are found.
KIHEFO bridges these gaps by bringing hospital-quality staff to the village level. At a major outreach, like the one I attended in Kakarisa, there was the General Clinic, where doctors check patients’ wide assortment of needs. If a patient requires blood work or other testing, they send it to the Laboratory. If they finish their examination but need medication before they leave, they will take their doctor’s note to the Dispensary. For anyone with Eye or Dental needs, there are separate areas with specialists on hand. Lastly, there is also Family Planning where women (and hopefully men) can come to receive guidance in their sexual and reproductive health.
In Kakarisa, our venue was the local primary school. This venue offered two major benefits to the KIHEFO team. Firstly, it was vacant, as students were on break. It had several rooms, which could be transformed into the health areas I noted above. It had a large grassed area in the middle, for a waiting area. And, lastly, it was centrally located in town and easy for everyone to find.
As someone without any medical background, I was unsure where to help. Some of the other students started in the Dispensary, helping to un-box medications and sort them for distribution later in the day. Some shadowed the doctors, while other assisted in the lab with testing. I was less eager, so I stood outside the makeshift hospital areas and eventually landed on a bench in the center of all the newcomers, in Intake.
Coordination was relatively simple. The administrators to my left created an information slip for every patient that arrived. It had their name, age, gender, village on the top. They were then asked to stand on a scale to acquire their weight, which was also added to the form. My role was to then hand them one of three sheets, each with a number on it to represent their place in line. There was one stack for general clinic, another for dental, and a final pile for eyes. In the end, we had seen over 200 patients for general clinic and over 30 for the dental and eye clinics each.
It was extremely fast-paced with commotion as people waited hours (not including their travel time walking) to see a doctor. But there was some humor during the day. One woman who wanted a second slip of paper pretended that she was a twin and had not received anything yet. As the level of English here was low to nonexistent, I heard many of these things after the fact, usually by asking why the women were laughing.
In the afternoon, after things began to slow down in Intake, I walked around and tried to peek inside the rooms to see what everyone else was up to. I eventually landed outside of the General Clinic, asking how I could help. One of the coordinators handed me about five of the information forms I had seen at the start of the day and told me to manage the queue. On the outset I was quite disoriented, mostly because there was no queue, everyone was sitting in front of me, like an audience.
I announced the name on the top of the stack as one of the three nurses inside released their current patient. After a while, one of the nurses pointed out where the queue starts – where the foot path cut the grass into two – and I began to enforce it vigorously. The men on the left were trying to jump the queue. I was having none of it. I would grab another five slips and politely ignore their attempts to thrust their papers into my hand. After a few cycles of this, they got the message and stood in line like all the other men, women, and children were doing. Order restored!
On my second outreach, to the village of Rubira, I would be working inside a clinic, not on the outside. I would spend the day with Joanne, a dentist, acting as her assistant. This was a much smaller outreach, as KIHEFO comes here monthly and the village is much closer to town than Kakarisa.
Our first patient was a girl of only 14 years whose mother requested two ‘extractions’. Due to a number of overlapping reasons – poor oral hygiene or just being poor – this girl was to have two teeth removed, permanently. Her fear was palpable. Simply looking inside her mouth with the traditional tool of a mirror caused her to wince and cry. It was not going to get easier. Joanne administered a local anesthesia to allow for the extraction to take place with a minimum level of pain. But this action – inserting a syringe into the gums and releasing the fluid – caused its own pain. A metal object with a pick at one end and a handle is then wedged on both side of the tooth removed. The last implement, a pair of dental pliers, pulls the tooth out. This required the mother to hold down the girl and Joanne to move quickly. I have never seen so much fear in a person’s eyes. Well, I was going to see a lot more of it.
Joanne and I saw 4 patients under the age of 18 who together lost 6 teeth that day. An older man also visited the clinic but didn’t actually need any dental treatments. Many of the teeth we removed that day could be saved, but the opportunity to receive a ‘free’ tooth extraction was too good of an offer to pass up – the cost of filling a tooth would be too much for anyone in Rubira. Sadly.