A 40-mile drive north from Kampala, Uganda’s capital, will take you to Luwero, the principal town of a region once known as the ‘killing fields of Africa’, after the civil war of the 1980s which left over 250,000 dead. Today the town bustles with the organised chaos typical of East African marketplaces and taxi parks, and visitors can pass through
relatively unaware of the systematic destruction of livelihoods and lives that took place two decades ago.
For the equivalent of about sixteen pence one of the many share taxis will take you half an hour along a dirt road (with more than it’s fair share of potholes) to Kiwoko, a small town deep in the Luwero triangle, and home to one of Uganda’s larger mission hospitals, seeking to reach out to people whose lives have been devastated by war, poverty and disease.
Founded in 1988 as a clinic on the steps of a bullet ridden church building by Dr Ian Clarke, a GP from Northern Ireland, Kiwoko has grown steadily to become a 200 bed hospital on a fifteen acre site with facilities including an operating theatre and ultrasound room. I had the opportunity to spend two months here and experience many of the different aspects of the work including adult inpatient care, paediatrics, maternity and community health. The following is simply a couple of ‘snapshots’ from one or two of my days in Luwero.
We start the day with a ward round at 7.30am. I am working on one of the adult wards this week so there are about fifteen to twenty patients to see. The sister in charge leads us in a prayer for the patients and staff and then we go round the ward, finding out how each person is feeling, assessing how their condition has changed overnight, what impact the treatment is having and deciding on a plan for the coming twenty-four hours. It is encouraging to see that some patients are improving, and we make plans to discharge several people later in the day.
By 8.15am the Morning Prayer meeting has begun. This is the focal point of the day for staff and about a hundred of us, including a large number of students from the nursing school, gather together to praise and worship. After joining in choruses in both Luganda and English, Daniel, one of the hospital staff, shares about a mission in a nearby village the previous weekend. A significant number of people have responded, through both the large meetings that were held and the home visiting. The local churches have been encouraged by the visit of the hospital team and plan to follow up on the work done over the weekend. It is wonderful to see the integration of medicine and missions at Kiwoko - this is not just a hospital run by Christians or a mission with a medical focus - but a holistic ministry responding to the needs of the people of Luwero - be that spiritual, physical or material.
The doctors meet together for an hour after prayers to discuss any difficulties or issues arising from admissions during the night. Each day someone prepares a short presentation or series of questions to provide some continuing medical education.
Unlike in the UK, postgraduate medical education is very limited in rural Uganda and this is an important part of the hospital routine for the doctors, many of whom are only a year or two out of medical school, to increase their learning and reflect on their practice. The remainder of the day is taken up by arranging discharges, organising and chasing up test results and continuing to monitor the condition of the patients on the ward. Throughout the day I see a number of people who come in to outpatients as new admissions. Early in the afternoon I admit a lady with a mild headache who is otherwise well. Over a course of a few hours she deteriorates rapidly and begins fitting and drifting in and out of consciousness. She is HIV positive and her lumbar puncture shows that she has meningitis. Overnight her blood glucose becomes very high and she develops diabetic ketoacidosis. Despite all the treatment that we can offer, she dies during the ward round the following morning. Her family were aware that she had AIDS, and although devastated by her death, accept it very straightforwardly, saying that ‘God has decided’.
Throughout my time in Uganda I am struck by the simple yet profound grasp that the people have of the sovereignty of God, not as a theological abstraction to be debated, but as a reality essential to their day-to-day survival.
Kiwoko is very well equipped for a rural Ugandan hospital, but facilities are still limited compared to the UK, and it can be a challenge to determine what is wrong with people. Between 15 and 20% of the adult population are estimated to be HIV positive and account for about 60% of adult admissions. When they develop full-blown AIDS, these people become ill very quickly and get unusual and often multiple conditions. Although the infections can be treated if caught rapidly, there is no cure for AIDS and access to the anti- retroviral drugs that have dramatically improved prognosis in the West is negligible in Uganda. Later on in the week I have the opportunity to see the work that the hospital does in the field of AIDS care when I spend an afternoon with one of the community health teams.
Uganda is to date the only country in Africa that is successfully reducing the rate of HIV infection and in some ways is becoming a model for the rest of the continent. There is an increasing openness about the nature and the scale of the problem, and a massive public education campaign that is obvious if you read any of the country’s main newspapers.
Despite this, however, the impact the condition continues to have in rural areas is simply massive. On Thursday afternoon we leave Kiwoko in a jeep with doctor, a nurse, and two health workers. The first visit is to see a 2-year-old girl with HIV who recently went home from hospital following an admission due to malnutrition and pneumonia. She is much better than when she was admitted to hospital but is still very underweight and has extensive sores around her mouth, which are hindering her feeding. Her father died of AIDS and her mother, who is well at the moment, but who is also HIV positive, is caring for her. As we give treatment for the sores and advice about nutrition many of the children from the surrounding homes gather around the jeep. The community team has recently received a large number of donated clothes and we are able to give out T- shirts, shorts, dresses and some simple toys. It is humbling to see the delight on the faces of the kids as they try on the clothes. Their previous T-shirts are full of enormous holes and I find it incredible that the gift of these new ones, which are well worn and would probably be thrown out at home, can make such a difference.
We go on to visit other children with AIDS, some of whom are caring for themselves as both parents have died, and adults with the condition who are living alone or with other relatives. At times it is frustrating to feel that we can offer so little, yet the people are genuinely delighted that we have come to see them, and often some very basic medical care will make a big difference. Many times we have the opportunity to pray with people before we leave – to ask God to bless them and their families, that they would know His love, healing and provision, and that what practical help we could offer would make a difference in their lives. Before I went out into the villages I thought that to pray such things with people who have so little would be cheap and insincere, but in fact joining in prayer was the most valuable aspect of the ministry, and often the part of the visit that was most appreciated by the patients.
Uganda has made an incredible recovery from the years of civil war but the fallout of the conflict and the AIDS epidemic in terms of disease and poverty continues to call for a response that is both spiritual and practical. It was a privilege to be allowed to spend two months amongst people who are part of that response. I am grateful to MMA HealthServe, for their financial support in helping to make this time possible.
For further information on the work of Kiwoko Hospital please visit the Friends of Kiwoko website (http://www.fokh.org.uk) which includes information for medical students interested in doing an elective at the hospital.
For the equivalent of about sixteen pence one of the many share taxis will take you half an hour along a dirt road (with more than it’s fair share of potholes) to Kiwoko, a small town deep in the Luwero triangle, and home to one of Uganda’s larger mission hospitals, seeking to reach out to people whose lives have been devastated by war, poverty and disease.
Founded in 1988 as a clinic on the steps of a bullet ridden church building by Dr Ian Clarke, a GP from Northern Ireland, Kiwoko has grown steadily to become a 200 bed hospital on a fifteen acre site with facilities including an operating theatre and ultrasound room. I had the opportunity to spend two months here and experience many of the different aspects of the work including adult inpatient care, paediatrics, maternity and community health. The following is simply a couple of ‘snapshots’ from one or two of my days in Luwero.
We start the day with a ward round at 7.30am. I am working on one of the adult wards this week so there are about fifteen to twenty patients to see. The sister in charge leads us in a prayer for the patients and staff and then we go round the ward, finding out how each person is feeling, assessing how their condition has changed overnight, what impact the treatment is having and deciding on a plan for the coming twenty-four hours. It is encouraging to see that some patients are improving, and we make plans to discharge several people later in the day.
By 8.15am the Morning Prayer meeting has begun. This is the focal point of the day for staff and about a hundred of us, including a large number of students from the nursing school, gather together to praise and worship. After joining in choruses in both Luganda and English, Daniel, one of the hospital staff, shares about a mission in a nearby village the previous weekend. A significant number of people have responded, through both the large meetings that were held and the home visiting. The local churches have been encouraged by the visit of the hospital team and plan to follow up on the work done over the weekend. It is wonderful to see the integration of medicine and missions at Kiwoko - this is not just a hospital run by Christians or a mission with a medical focus - but a holistic ministry responding to the needs of the people of Luwero - be that spiritual, physical or material.
The doctors meet together for an hour after prayers to discuss any difficulties or issues arising from admissions during the night. Each day someone prepares a short presentation or series of questions to provide some continuing medical education.
Unlike in the UK, postgraduate medical education is very limited in rural Uganda and this is an important part of the hospital routine for the doctors, many of whom are only a year or two out of medical school, to increase their learning and reflect on their practice. The remainder of the day is taken up by arranging discharges, organising and chasing up test results and continuing to monitor the condition of the patients on the ward. Throughout the day I see a number of people who come in to outpatients as new admissions. Early in the afternoon I admit a lady with a mild headache who is otherwise well. Over a course of a few hours she deteriorates rapidly and begins fitting and drifting in and out of consciousness. She is HIV positive and her lumbar puncture shows that she has meningitis. Overnight her blood glucose becomes very high and she develops diabetic ketoacidosis. Despite all the treatment that we can offer, she dies during the ward round the following morning. Her family were aware that she had AIDS, and although devastated by her death, accept it very straightforwardly, saying that ‘God has decided’.
Throughout my time in Uganda I am struck by the simple yet profound grasp that the people have of the sovereignty of God, not as a theological abstraction to be debated, but as a reality essential to their day-to-day survival.
Kiwoko is very well equipped for a rural Ugandan hospital, but facilities are still limited compared to the UK, and it can be a challenge to determine what is wrong with people. Between 15 and 20% of the adult population are estimated to be HIV positive and account for about 60% of adult admissions. When they develop full-blown AIDS, these people become ill very quickly and get unusual and often multiple conditions. Although the infections can be treated if caught rapidly, there is no cure for AIDS and access to the anti- retroviral drugs that have dramatically improved prognosis in the West is negligible in Uganda. Later on in the week I have the opportunity to see the work that the hospital does in the field of AIDS care when I spend an afternoon with one of the community health teams.
Uganda is to date the only country in Africa that is successfully reducing the rate of HIV infection and in some ways is becoming a model for the rest of the continent. There is an increasing openness about the nature and the scale of the problem, and a massive public education campaign that is obvious if you read any of the country’s main newspapers.
Despite this, however, the impact the condition continues to have in rural areas is simply massive. On Thursday afternoon we leave Kiwoko in a jeep with doctor, a nurse, and two health workers. The first visit is to see a 2-year-old girl with HIV who recently went home from hospital following an admission due to malnutrition and pneumonia. She is much better than when she was admitted to hospital but is still very underweight and has extensive sores around her mouth, which are hindering her feeding. Her father died of AIDS and her mother, who is well at the moment, but who is also HIV positive, is caring for her. As we give treatment for the sores and advice about nutrition many of the children from the surrounding homes gather around the jeep. The community team has recently received a large number of donated clothes and we are able to give out T- shirts, shorts, dresses and some simple toys. It is humbling to see the delight on the faces of the kids as they try on the clothes. Their previous T-shirts are full of enormous holes and I find it incredible that the gift of these new ones, which are well worn and would probably be thrown out at home, can make such a difference.
We go on to visit other children with AIDS, some of whom are caring for themselves as both parents have died, and adults with the condition who are living alone or with other relatives. At times it is frustrating to feel that we can offer so little, yet the people are genuinely delighted that we have come to see them, and often some very basic medical care will make a big difference. Many times we have the opportunity to pray with people before we leave – to ask God to bless them and their families, that they would know His love, healing and provision, and that what practical help we could offer would make a difference in their lives. Before I went out into the villages I thought that to pray such things with people who have so little would be cheap and insincere, but in fact joining in prayer was the most valuable aspect of the ministry, and often the part of the visit that was most appreciated by the patients.
Uganda has made an incredible recovery from the years of civil war but the fallout of the conflict and the AIDS epidemic in terms of disease and poverty continues to call for a response that is both spiritual and practical. It was a privilege to be allowed to spend two months amongst people who are part of that response. I am grateful to MMA HealthServe, for their financial support in helping to make this time possible.
For further information on the work of Kiwoko Hospital please visit the Friends of Kiwoko website (http://www.fokh.org.uk) which includes information for medical students interested in doing an elective at the hospital.
