Bringing the Hospital to You: KIHEFO Health Camps in Rural Uganda

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.


What Can a Rabbit Do?

The World Food Programme (WFP) and the World Health Organization (WHO)  have both identified malnutrition as a major factor in preventing the Ugandan people from moving out of poverty and into more substantial development. According to the WFP:

One in three Ugandan children suffer from stunting, a lifelong condition that results when children miss out on critical nutrients such as proteins, vitamins and minerals while in the womb or in the first five years of life. People affected by stunting are more likely to suffer from illnesses, drop out of school, be less productive at work and live shorter lives.

When one visits Uganda’s rural areas, you see hills rolling in lush greens – cassava, maize, sweet potatoes, and other grains and vegetables growing – but this oasis of vegetation does not prevent malnutrition by itself. It is the right combination of foods and healthy activities, including intensive breast feeding, which can prevent malnutrition from occurring in a child’s early years.

Uganda “spends [millions] per year treating cases of diarrhoea, anaemia and respiratory infections linked to malnutrition” (WFP), while also losing revenue as the citizens underperform in school and at work due to stunted childhoods. Western Uganda is suffering from malnutrition even more so. There, 44% of children are affected by malnutrition. Proper prevention of the causes of malnutrition would have immense positive impact on Ugandan families and the country as a whole. So, KIHEFO is tackling the problem.

So, what can a rabbit do (to solve malnutrition)?

Actually, quite a lot!

Rabbits feed families. Farmers gather inedible material like weeds, grass, and vegetable scraps to use as food for rabbits, which are a great source of protein and nutrients.

Rabbits breed quickly. If properly cared for, a female can produce a litter of half a dozen rabbits each month.

Rabbits produce fertilizer.  Rabbit droppings can be collected easily and used as an organic fertilizer to improve soil quality and overall yields.

Rabbits generate revenue. In the market, a rabbit can be sold for 15,000 Ugandan Shillings (equivalent of $6 US Dollars) which helps generate small income for poor households.

For these reasons, rabbits can be the vehicle to solving the problem of malnutrition in Uganda (and other countries). Rabbits can improve people’s diets and current farmland, but also provide the income to source other necessary components of a proper diet.

KIHEFO has researched using rabbits as a solution to malnutrition over the past few years, which led to the constructed of the Kigezi Rabbit Breeding, Training, and Processing Center outside of Kabale.

Inside you will find an assortment of cages. They are filled with five breeds of rabbits, to ensure diversity in future generations. Males and females are further separated, to allow for proper growth.

Cages are simply designed, made of wood and wire mesh. A door is needed to feed the rabbits and then remove the bunnies once they have matured.

Managed by Alphonse, a staff member of KIHEFO, the Center acts as not only the distribution hub for future clients. It also provides education through example. Outside is a small plot of kale that provides the food for the rabbits of the Center. Having everything locally available means that the Center is self-sustaining and requires low resources to operate.

In addition to setting up the infrastructure and initial supply of rabbits, KIHEFO is also conducting nutrition surveys in the outlying rural communities, identifying the most vulnerable populations – those dealing with disease and large numbers of children, many orphaned by HIV/AIDS. The villages of Rubira and Kicumbi have already seen the advantages of this program, with both families and communities starting their own rabbit breeding facilities. These are smaller in scale, but have the ability to grow.

If you want to support KIHEFO’s Rabbit Breeding Center and those families most in need, please let me know.

Hopes for Uganda

1280px-Flag_of_Uganda.svgToday, I will be flying from Edmonton en route to Uganda. This will be my second time on the African continent and a new chance to explore the world of development in depth. In Ghana, my biggest take-aways were adjusting to being a first time international traveler and doing development research projects. In Nicaragua, I focused all of my time and energy leading a team of other travelers.

This time, I will have the freedom to explore and to develop projects organically, based on what I find. I will be partnering with the Kigezi Health Foundation (KIHEFO) in Kabale, Southwestern Uganda. Some potential projects include local sources of nutrition and greater access to improved water, but these may change with time.

Some of my personal goals include:

  • growing my photography skills, so that I can share my experiences with people back at home;
  • improving mt writing, through regular blog posts here; and
  • becoming a better collaborator, by interviewing people and using their points of view in my work.

Stay tuned for more in-depth reports.