The ACCT established partnerships to run medical clinics in 2018, giving us a new look. Blog written by Dr. Chris Morgan
The original intention in working with the Amahoro Children’s Home in Uganda was not to conduct medical clinics. On our first trip, a small group of committed individuals and physicians asked our host and friend, Caleb Rukundo, “What can we do for you?” It was an unusual question, because most foreigners come to Uganda and tell Ugandans what they need. Caleb said, “Do medical clinics and HIV testing”. Caleb has a true talent of figuring out what you really want to do and encouraging you to make it happen.
Caleb Rukundo and family in their home village with the Morgan family, 2017
This is the ACCT’s sixth year of doing medical clinics, and we had some momentous firsts. This was our first year that we were able to track demographic data – resources are limited when you set up a clinic in the bush – and we have been able to share that information with Jungle Medical Missions Uganda, run by our good friend Dr. Franklin. As well, it was our first year of doing combined medical clinics with Ugandan nurses and doctors, leveraging Dr. Franklin’s extensive network around the country to deliver care in 5 separate locations.
Six years ago, our medical clinics were done in the open, in what the locals call “the bush,” in the thick grass under a tree, searching for relief from the sun and rain. We even had to treat one of the clinic workers when in insect came down from above in 2017. Our first clinic this year was inside the church instead between the shrubs. We had a full lab, HIV testing and counseling, six Ugandan nurses, a Ugandan doctor we could consult with or arrange follow up with for our patients, individual exam rooms, and a nearly full pharmacy with over 75 different drugs. In partnering with local help, not only were we invited inside the church, but our services were legitimized as well.
Clinic in the church in Nakasongola, 2018
In Uganda, there is one doctor for 20,000 patients. Not one specialist, or one practice. One doctor. So many Ugandans have never seen a medical doctor. While the health system may be limited, it is organized to get as many patients as possible to care in the smoothest way possible. Below, here is a rough layout of the country’s organization.
Health Center 1: Village Health Team
Health Center 2: Parish: There is a nurse and a midwife, but sometimes no drugs
Health Center 3: County level: This is the first center that has a lab. They can take blood samples and are ran by clinic officers. Similar to PAs. What they can’t handle they can refer to health center 4
Health Center 4: District Hospital. First level where they can do IV drugs. The first time you are going to meet an OR. Serves hundreds of thousands of people. These centers can handle life threatening emergencies. The first time you meet a medical officer. There are 2 Doctors with a lab and nurses
Regional Hospitals: specialist clinics. Dentists, GYNs, etc.
National Hospital in Kampala: You can find many specialists and consultants. The first time you see an ICU. The ICU only had 4 beds before renovation
Asha from the Youth & Community Health Counseling Initiative for individuals with HIV & AIDS
This year we had the opportunity to practice protected against malpractice. Even when you do everything right things can go wrong. So this year we officially worked under a Ugandan license thanks to a local connection. This was another potential crisis averted thanks to local expertise.
Our clinical demographic data collection was coordinated between Dr Franklin, our gracious mentor, and Matt Miner, one of our group. This was customized database keeps track of personal information, diagnoses, medications given, and follow up if any. This system allowed us to monitor and track patients and communities in ways we never have, and we will be using a computer-based system in the years ahead.
Registration run by Amahoro Children’s Home Administrators Peace and Hapi
While we have had Ugandans as translators at clinics before, having a Ugandan nurse was a benefit. They understood where the interview was going and made a safety net if we did something unusual. They might say “doctor, are you sure?” The joy of working with a nurse!
Another thing we learned from Dr. Franklin was that the Ugandan patient must leave with a prescription of something for them to be satisfied with the visit. This is something we learned long ago through experience and we had confirmed this year, in Dr. Franklin’s medical introduction, and why will still bring tens of thousands of Ibuprofen and Tylenol. Dr. Franklin suggested deworming medicine and vitamins as placebos as well. This novel concept of placebos that actually benefit the patients needs as well is a one we are glad to know!
We have made significant improvements this year providing medical options to Ugandans in remote villages. Although healthcare is free, the system is strained. All the while we are learning how to improve our practice as well.
Our goal is not to create an American Healthcare system in Uganda or for us to adopt a Ugandan Health delivery system, but to try to find a blend, a union between the two We are US doctors in their East African country, treating their people, but if we can all learn and strive to do a better job and create a better world, we must!
Grandma “Jaja” Jean running eye checks
Annette, Dr. Franklin’s clinic administrator, monitoring a clinic that saw over 200 patients in one day
Snapshots from the clinic in the Evangelical church in Nakasongola
The ACCT is committed to providing educational and medical services and support to vulnerable children and their communities throughout Uganda. At the core of it, the ACCT is a service organization; we partner with educators and medical professionals to give our time and work alongside local experts.