Namulaba Update Newsletter

8/20/2019 Namulaba Update Newsletter

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In this Edition

Director’s messagPg 2

Musisi speaks ou

Pg 5

Wanaka’s

testimony Pg7

Namulaba visitor

Pg 9

Service Reports P

Namulaba Update Jan-Feb 2008

A patient being registered at the reception whileothers wait for their turn

Services for HIV and AIDS Patients: A small but growing proportion

of patients are known HIV and AIDS cases attending routinely for

clinical follow up and refill of their supply of Septrin for prophylaxis of

opportunistic infections. Overall in the first six months 8.7% of the

patients seen were HIV and AIDS patients returning for routine follow

up. In addition to attending the medical clinic the people living with

HIV and AIDS (PHAs) also attend a support group meeting every

Thursday.(Continued on Pg 8)

How about Malaria?

“…one of the excitements

get out of this work is tha

when a little girl is brough

with a fever I am able to

order a blood slide formalaria parasites and if I

find the parasites I treat

the child using the

efficacious Artemesinin

Combination Therapy

(ACT). … We are grateful t

AVERT to have made it

possible for us at

Namulaba to provide this

service which is not easy

for people to access

elsewhere.”Director

To reach Namulaba Health Centre (NHC) from Kampala you take Jinja

road and take a left turn at a trading centre called Namataba (35 Km

from Kampala). NHC is located 8 Km further inland on a dirt road. It is

in Nagojje sub-county Mukono District.

I took another test in 2001 from

Mengo Kisenyi AIC Kampala but the

results were still positive. The

counselors of Mengo Kisenyi AIChelped me a lot by counseling me and

giving me hope.

The results came out positive then I

opened up a file and begun on

treatment. Although I accepted to go

for the blood test, I would go to

hospital secretly because I did not

want any of my family members to

know that I am HIV positive.

Florence Wanaka.


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Newsletter for Namulaba Health Centre Jan-Feb 2008

! Director’s Message

Imagine you are a health worker who

works on HIV and AIDS but you have

bought land in a remote location, where

you think people do not know you, to

develop a retirement farm. What would

you do if when you reach your farm, you

find a sick looking woman with a 2 year

old daughter who has a high fever and

she asks you for help? She says she has

been told that you are a doctor and that

she lost her husband and her 2 year old

daughter has malaria and she herself is

sickly and she has no money. Do you

immediately put her and her child into

your four wheel drive truck, which you

came with because the roads were so bad you could not use a simpler car,

and take her to the nearest hospital one

hour’s drive away? And what do you

think you would find there? I bet you

would find an outpatient department

that is operated by un-motivated under-

paid staff. You would find that they are

short of basic supplies and medicines,

that their labs do not have the

necessary reagents and that the facility

is over crowded with patients and theydo not have a constant supply of

electricity and water.

Or do you tell her that you do not have

any equipment and medicines on you

and advise her to go seek health care at

the nearest public health facility? Or do

you give her some money and tell her to

seek care at the nearest private clinic? I

can not remember what I did but all I

remember is that I left with a very

depressed mind. I probably talked to

her about her problem and asked her to

seek care somewhere.

But that was a turning point in my

farming dream. I had bought this land

in a remote rural village called

Namulaba in Mukono district, located

one and half hours drive from Kampala

as an ideal place to develop my

retirement farm. And I was slowly

beginning to work on it each time I

came to my country, Uganda for

holidays. But now the people around

had discovered that I am a doctor. And

that I am a doctor who had worked on

AIDS in The AIDS Support Organization

(TASO), a kind organization that

provides AIDS Care and support at no

cost. For this reason, it appears, people

needing this kind of help were being

advised of the day I would come to the

farm and they would come and wait to

seek help from me. Indeed it was not

only that woman with her 2 year oldthat approached me. Each time I came

over to the farm there were one or two

desperate people seeking such help

from me.

In my previous life while working in

Masaka Hospital (1985 to 1989) I had

provided primary health care to a

deprived rural community by the lake

side in a village called Buwunga. I used

to buy a stock of medicines and I wouldgo with them in a bag and operate a

clinic in the home of the parents of a

friend of mine called Peter. For a while I

thought of doing that at this new farm

place, Namulaba. But there were two

major limitations. One, I was not happy

with the quality of medicine I had

practiced in Buwunga because I used to

work alone with no other staff, I did not

have lab back up and I had a limited

variety of medicines. I had practiced

bush medicine and I did not like to do it

again. Second, the people in Buwunga

were wealthier and they could afford to

pay for the costs of that medical care on

a for-profit basis. But the situation I

was now faced with in 2004 in

Namulaba, was different. The people

were too poor to pay, even at cost price,

A Community AIDS ro!e"t based at a Not-for-ro#t Health Centre 2

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for the care. So I could not repeat the

Buwunga service here in Namulaba.

After tossing these thoughts in my mind

I got a vision to build a health centre on

my farm land which I would operate as

a privately owned facility to provide a

public service using public funding.

And so on 5 February 2005 we laid the

foundation stone of the Namulaba

Health Centre. During the prayers that

were held that day at the site I publicly

made a commitment that the building

would be completed in two years’ time.

And by God’s grace on 30 June 2007,

only four months later than the dream

date, the building was operational and

we conducted the first medical clinicand VCT service. This means that the

dream of having a health centre in that

location had become a reality.

There are certainly many friends we are

grateful to for turning this dream into a

reality. My own source of income,

namely my employer, the International

AIDS Vaccine Initiative (IAVI) was

crucial for this success. If I had not

been employed I would not have beenable to put up the structure. But the

structure alone would not have

delivered the services. We are very

grateful to AVERT: Averting HIV and

AIDS worldwide, a UK based charity, for

giving us a grant to equip the health

centre and provide primary health care

for the first year of the project. At the

time of writing, we are anticipating that

this grant will be extended for another

year as we work out a more sustainable

funding framework.

We have also been visited by a number

of friends who have given us highly

appreciated moral support, advice and

some material support. I will not be able

to mention all but permit me to mention

my four Swedish friends Mr. and Mrs.

Ortendhal and Mr. and Mrs. Sund who

attended one of the drama competitions

and gave us some gifts; Bishop Paul

Luzinda of Mukono Diocese who visited

and blessed the building; my TASO

friends: Noerine, Peter, Jane and Elly;

and my WHO friend Sandra and her

daughter Janna.

From the need to provide care for people

like that lady who came with a two year

old girl who had a high fever, the

initiative evolved into a project to

respond to HIV and AIDS in this

community using a three pronged

approach as follows. First of all the

nucleus of the project is Primary Health

Care provided to all communitymembers regardless of HIV status. The

rationale for this approach was born out

of the reality that in a village with a

mature HIV epidemic, most health care

needs of a family are related to HIV and

AIDS. The ill person presenting for

primary health care could have HIV, or

s/he could be a care giver for an HIV

patient or could be a child of an HIV

positive client. Hence, the provision of

primary health care will most likely becontributing to the relief of the family

from the suffering due to HIV and AIDS

and the associated medical and social

ills.

Also, although not so popular a view, it

hurts me to think that a little child or

an old woman should be left to die of

malaria just because they do not have

AIDS. Hence one of the excitements I get

out of this work is that when a little girl

is brought with a fever I am able to

order a blood slide for malaria parasites

and if I find the parasites I treat the

child using the efficacious Artemesinin

Combination Therapy (ACT). Once again

we are grateful to AVERT to have made

it possible for us at Namulaba to

provide this service which is not easy

for people to access elsewhere. Further,


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we provide HIV counseling and testing

and those found positive are provided

Septrin prophylaxis and are referred to

Kawolo hospital to seek ARVs. But they

also join the support group and

continue to attend the monthly medical

clinic for follow up and refill of their

Septrin supply.

The second prong of the project is a

comprehensive community response to

HIV and AIDS. To start with the project

started with community seminars.

These were overtaken by the annual

music, dance and drama (MDD)

competitions which climax in the final

competitions at World AIDS Day each

year. The MDD performances that tookplace in 2006, before the

commencement of services at the clinic,

did make me nervous when they were

always depicting scenarios where HIV

testing and care were provided at the

Namulaba health centre. I was nervous

because the building was not yet

complete nor did we know where we

would get the money for the equipment,

supplies and personnel to run the

services. But we are grateful to AVERTthat they came in to our help.

The latest element to join the

community band wagon is the

community health workers. This fine set

of ten highly motivated community

members has started their work by

carrying out a hygiene assessment from

village to village. In each village the

findings from this hygiene assessment

are discussed with community members

and used as an entry point to discuss

general health issues including HIV and

AIDS. The CHW are using a special

approach where they engage individuals

to discuss with them personal HIV and

AIDS issues without the individuals

inviting them to. In other words rather

than waiting for the clients to go to

them they go to the clients.

The third prong is the Namulaba

Network of CBOs (Community Based

Organizations). This network has 18

member CBOs that signed the

constitution in July 2007. Thereafter

the Network was registered in August

2007. Namulaba Health Centre is a

member of the CBO Network which has

an elected committee chaired by Mrs.

Margaret Kizito who is also the Speaker

of the Local Council 3 of the sub-

county- a prominent person. I also seat

on the committee of the Network

representing Namulaba Health Centre.

The Network committee has theresponsibility to oversee all the non

clinical matters of the project including

the Music Dance and Drama

competitions and the work of the

Community Health Workers. They also

manage the user fees of Uganda Shs

1000 (about 60 US cents) per client

collected during the clinic. The aim of

the project is to gradually increase the

responsibilities of the Network as their

capacity to manage grows until such atime that they can write proposals,

receive, manage and account for funds.

At the moment I am providing this

support from my private office in

Kampala and the Administrator at this

office is charged with the responsibility

of giving administrative support to the

Network while building their capacity.

Let me invite you to read and enjoy the

rest of the newsletter. Namulaba is one

attempt to cover the many gaps that we

have in our response to HIV and AIDS.

We are working towards an ideal African

village where everything that can be

done about AIDS is being done for every

person all the time. We are reaching just

a few people but with your support we

can reach more. Come and visit with us.


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We have community health workers’

training meetings and CBO network

meetings every second Saturday of the

month. You are welcome to join, listen

in and share. We have the medical clinic

and VCT every last Saturday of the

month. Depending on your skills you

can come and work as a volunteer

counselor, nurse, lab tech, clinician or

just a volunteer to guide traffic. The

clinics are heavy we usually have a 100

plus people. If you come before 9.00 am

you can join us in the prayer meeting

and you can also give a health talk to

the waiting clients. At any time you can

give us advice and you can also make a

donation.

Together we can make a difference for

the few that we reach.

Dr Samuel Kalibala

[email protected]

3. Musisi Speaks Out

In 2000 I was working with Coca Cola

as a sales manager. I fell sick, that is to

say I got a high fever and a herpes

zoster. I went to the clinic and the

doctor prescribed for me medicine for

the herpes zoster. By then my wife was

working in a pharmacy so I told her to

give me the prescribed medicine. She

got so scared after reading the type of

medicine the doctor had prescribed for

me then she told me that we might be

infected with HIV. She then suggested

that I go take a blood test.

I was staying in Bugiri town but I

decided to take a blood test from Kawolo

hospital because I never wanted peoplein Bugiri to see me testing for HIV,

besides Kawolo hospital is near my

home village. After testing the doctor

broke the bad news to me that I was

HIV positive. I broke down, got so

worried and my mind was filled with

thoughts. When I told my wife that I am

HIV positive she became so furious and

bitter putting all sorts of blame on me,

she separated from me immediately. The

situation became worse because the

fever was not curing. I started getting

joint pains and I could not go to work

any more because I was becoming

weaker. The Managing Director Coca

Cola could not wait for me any longer so

he decided to give out my job. I could

not afford the rent any more since I was

jobless. Therefore I decided to go back

to my village area Masiko LC1, Wagala

parish, Nagojje sub county Mukono

District.

However I doubted the results from

Kawolo Hospital. I took another test in

2001 from Mengo Kisenyi AIC Kampala but the results were still positive. The

counselors of Mengo Kisenyi AIC helped

me a lot by counseling me and giving

me hope. They told me that as long as I

live a positive life and take my

medication as required every thing

would be fine. I was referred to

Nsambya Home Care for treatment. I

registered with Nsambya Home Care

and started on my treatment

immediately. I found transportdifficulties since I was staying very far

i.e from Masiko to Kampala I would

spend Shs10,000 and more which was

so expensive for me since I was not even

working. So at times I would not go to

hospital because of lack of transport.

Besides that, most attention was put on

people who stay around Kampala and

those who do not exceed ten miles.

Eventually I failed and gave up.

On learning that Kawolo hospital was

also treating HIV/AIDS patients, I

registered with them in July 2004. It

was an advantage to me because my

home village is not far from Kawolo

hospital. After registering with Kawolo

hospital, Dr.Kiyimba advised me to take

a CD4 test immediately because my


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condition was very bad. My CD4 results

came out showing that my White Blood

Cells were only105. So that was my

starting point. I started on ARVs but my

only prayer was that I do not get any

side effects.

When I went back to my community, we

formed up a group called Mukono

District Network of PHA Nagojje branch.

This group was counseling people and

sensitizing them about HIV/AIDS. The

coordinator of this group called

Mr.Musisi Gavah after realizing that I

was so interested in counseling others,

he promised to help me join

organizations that can train me in

counseling and guidance. One year

after, I received a phone call fromMr.Musisi Gavah informing me to go

and attend a training session led by

Hospice Africa Uganda about

community volunteer workers

(Traditional healers in palliative care of

cancer and HIV/AIDS patients and their

families) where I was awarded a

certificate on 29th July 2006.

One month later on 22nd Aug 2006,

Mr.Musisi Gavah called me again to join

Mild May and I attended a course incommunication and counseling skills

Still I was awarded a certificate.

In the same month he called me again

to join Mukono District HIV/AIDS

project where I trained to get basic

counseling skills. I was again awarded a

certificate on 30th Aug 2006. The more I

joined those projects, the more I made

friends one of them being Mr.Byansi

Lawrence who is a coordinator of

MUMYO (Mukono Multi-purpose Youth

Organization)Mr.Byansi connected me to

Population Services International (PSI)

where I trained as a peer educator and I

was awarded a certificate on 12thNov

2006.

In April 2007, Mr. Musisi called me at

his home and he informed me about a

new organization that had come up

called International HIV/AIDS Alliance

Uganda (IHAA). It wanted to train Net

work Support Agents as well as

counselors. Since I had a lot of interest

in counseling and HIV/AIDS seminars,

Mr.Musisi Gavah chose me out of the

many. IHAA went to Kawolo hospital

HIV/AIDS clinic to find out which

person would be recommended. Still my

name was given in.

From there, IHAA went to Mukono

District and asked the District HIV focal

person Dr.Konde who also

recommended me. However two people

were needed i.e male and female

therefore Mr. Musisi Gavah

recommended Namusoke Grace who is

now my colleague at Kawolo hospital asNSA/counselor. I was awarded a

certificate by IHAA in community

engagement training workshop in

March/April 2007. After that training,

the IHAA connected me to PSI where I

was awarded a certificate in HIV basic

counseling and palliative care package

as a peer educator on 25thSept 2007.

IHAA has been giving us refresher

courses every after three months. I and

Mugerwa Badiru are the only peoplethat qualified as NSAs in Mukono

District. The criteria followed to choose

NSAs was;

• HIV/AIDS training

• Literacy skills, at least Senior

Four certificate

• Managing workshops and other

forms of training

We were taken to the Lake Country

Club at Kiggo Entebbe road for training

as trainers. I was awarded a certificate

on the 12thOct 2007.

Before the IHAA, Dr.Kalibala Samuel

informed people of Namulaba that he

was starting up a clinic there and his

main concern was about treating the

HIV/AIDS patients. On the day of the

seminar at the clinic, I got a chance to

declare myself HIV positive and I asked


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Dr. Kalibala if I would join him in the

fight against AIDS. He gladly accepted

me to join him. That was when we

started sensitizing people about

HIV/AIDS. We gathered here at the

clinic once in a month sensitizing

people about HIV/AIDS for a period of

six months.

Lunch was provided for the people who

attended the sensitization seminar. Dr.

Kalibala assigned me a task of following

up our clients. I would bring back the

report and the doctor would give me

some transport allowance.

When the clinic started operating,

Dr.Kalibala recruited me as an HIV

counselor.

I would like to take this opportunity tothank him for being good to me and an

easy person to work with who does not

discriminate against any individual. My

God bless him. Currently I am the

coordinator of the Community Health

Workers at the clinic, I am also

responsible for training/facilitating the

community health workers and I am a

counselor at the same time.

My responsibilities include:-

•

Educating and giving awarenesson facts about HIV/AIDS and

issues on ARV treatment.

• Advocating for stigma reduction

both at the health centre facility

and in the communities.

• Through the referral system, I

guide individuals, families and

communities to service outlets.

• Community follow-up of clients

taking ARVs in the community

and promoting adherence to

treatment.

• I also do pre and post test

counseling at the health facility.

• Providing adherence counseling

to clients on ARVs.

• Carry out supportive counseling

both at the health facility and in

the community.

• I mobilize people living with

HIV/AIDS to join support

groups.

I would as well like to take this

opportunity to thank IHAA Uganda,

Chief of party Mrs. Milly Katana and

other IHAA staff including Mrs. Emily

Katamujuna, Dr Salome Nampewo,

Thomas, Peter (driver) and the whole

entire staff of the Alliance for their

support. We do appreciate. My wife

came back, we resolved our issues, weare now happily married with six

children who are all HIV negative and

they all in school.

Mr. Musisi Aloysius

4. Wanaka’s Testimony

One time, around August 2005 as we

were on our village Kitto, we were told

that someone was planning to open up

a clinic in Namulaba.There was even aseminar that day. Out of curiosity we

went to Namulaba to find out what was

taking place. We found many people

gathered at Namulaba. Mr. Aloysius

Musisi was talking about himself

declaring to the whole public that he is

infected with HIV/AIDS and that he was

on treatment.

I was touched by everything Musisi had

said. When we went outside, I took

Musisi aside and I asked him where he

got the courage and strength to tell thepublic about his HIV status. He asked

me to go to his home so that he could

tell me more about himself. I informed

him that my husband had died of AIDS

and I was afraid of going to hospital to

test my blood besides I didn’t even know

where to start from.


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The following day, I went to Mr. Musisi’s

home. When I got there he counseled

me and convinced me to go for a blood

test. I became strong and decided to go

to Kawolo hospital for a blood test. The

results came out positive then I opened

up a file and begun on treatment.

Although I accepted to go for the blood

test, I would go to hospital secretly

because I did not want any of my family

members to know that I am HIV

positive.

I continued going to Mr. Musisi for

counseling who later on advised me to

open up and inform my family that I am

HIV positive. One time we were seated

at home with my sister and her co-wife I

opened up to them that I had tested forHIV and found positive. I even told them

that I had registered and opened a file

in Kawolo hospital and that I was on

treatment. They were so happy about

what I had done, I felt relieved from a

heavy load. On that same day, I advised

my sister with her co-wife to go for blood

tests and they accepted. Good enough

that very day was the first day of service

of Namulaba health centre so I went

along with them and they took the

blood tests. I carried on with advising

both the ladies and gents to go for blood

tests so that they can get to know their

HIV status. Whenever the health centre

operated, I would at least come with one

or two people and take them to the

counselor. People on my village started

consulting with me then I would tell

them the truth. I would like to thank

Mr. Aloysius Musisi who became a great

man and showed us the light. This is

the life I am living now. My thanks also

go Dr.Kalibala Samuel for what he has

done and his good plan. We are enjoying

the fruit of his good plan. We really doappreciate your services at the clinic

which has turned us into what we are

now. Especially treating us for free

without paying a single penny. Inside

me I am filled with life both body and

soul. Let me finish by saying God bless

you.

Ms Wanaka Florence

Services for PHA (cont)

Some of the PHAs are receiving ARVs at Kawolo Hospital or Jinja Hospital. Kawolo

Hospital is the closest hospital located on the main road from Kampala to Jinja adistance of about 10 Km from Namulaba Health Center. ARV services are provided by

the Joint Clinical Research Centre (JCRC) which is funded by PEPFAR to target widows,

orphans and PMTCT mothers and their families. Clients falling out of these categories

are charged Shs 20,000 to receive CD4 testing. At Kawolo Hospital also the MOH

program funded by the Global Fund provides free ARVs to all patients but does not

provide CD4 testing. Jinja Hospital is located about 50 Km away from Namulaba. It

provides free CD4 testing and the bus fare to and fro is Shs 10,000 thus some clients

find it cheaper to seek CD4 testing at Jinja hospital and then return to Kawolo Hospital

to seek ARV care.


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5! Namulaba "isitors

American Missionaries

The Bishop of Mukono Diocese


9

Bishop Paul Luzinda Kizito. He visited the health center buildingon 24 Sep 2! before it was co"pleted and he pra#ed for it andgave it a blessing. Here we see so"e $hristians greeting hi"while the Parish Priest %ev &ze'iel (ichael Kafeero )in white robe*and the La# %eader (rs. &sther +l#a )in blue robe facing ca"era*are loo'ing on. Another La# %eader )in blue robe bac' to ca"era*loo's on.

A"erican "issionaries, -ordan and Katie visited and ate lunch in ahut on the far" on 2 -une 2! when the# had co"e to carr# out"issionar# wor' in /a"ulaba village where the# spent a wee'living and eating in people0s ho"es. 1n the bac'ground can be seenthe inco"plete health center building.

Other visitors• Prof Elly Katabira, a

founder of TASO, visitedNamulaba at the laying

the foundation stone on

Feb 05

• Mr. Peter Ssebbanja, a

founder of TASO, visited

Namulaba at the laying

the foundation stone on

Feb 05. He also later

visited during the dram

competitions on 2 Dec 0

•

Dr. Jane Mulemwa , afounder of TASO, visited

Namulaba during the

drama competitions on

Dec 06

• Ms Milly Katana the Ch

of Party of the

International HIV/AIDS

Alliance in Uganda, visi

Namulaba on the 15 De

07. In the morning she

participated in the train

meeting of the Commun

Health Workers. In the

afternoon she attended

meeting of the CBO

Network.

• Dr Noerine Kaleeba, the

Founder and Patron of

TASO visited Namulaba

the clinic day of 29 Dec

She attended the Morni

Prayer meeting and gav

health talk to the waitinpatients.


10/15



10

(r. Peter Kanabus poses for a group snap with a cross section of /a"ulaba Health $entre sta)3r. Sa" in nec' tie*, "e"bers of the $B+ /etwor' $o""ittee and so"e $o""unit# Healthor'ers. +n the right side are school children and so"e co""unit# "e"bers who had

participated in the da#0s "usic, dance and dra"a activities. 1n the bac'ground is the Health

$entre building.

A5&%6 visitor (r. Peter Kanabus, husband of Annabel Kanabusthe 3irector of A5&%6, visited /a"ulaba Health $entre on 7

3ec 28 and here he is being presented a gift b# the $hairof the $B+ /etwor', (rs. (argaret Kizito. Loo'ing on is the$hair of the $o""unit# Health or'ers (r. Ki#aga who wastranslating between Luganda and &nglish.

The visit of Mr. Peter KanabusBetween 5 and 12 Dec 07 the

Director of AVERT, Mrs. Annabel

Kanabus and her husband Peter,

who also works for AVERT, were in

Uganda to visit Namulaba and oth

HIV/AIDS organizations. The 8th D

07 was the day scheduled for

visiting Namulaba. On this day eac

department of the project

participated in the show and tell.

The climax, as expected, was the

music, dance and drama

competition. Unfortunately, Mrs.

Annabel Kanabus missed all this a

she could not attend because she

was taken ill and remained in

Kampala. But she was ablyrepresented by Peter.


11/15


#!Reports by Departments

Number of clients seen in the first

six months of the health centre

The health centre provides medicalservices and HIV Counseling and

Testing (HCT) at every last Saturday of

the month. During the months of June

to November 2007 a total of 704

patients were seen of whom 623 (88.4%)

received medical care and 234 (33.2%)

received HIV counseling and testing.

Please note that some clients received

both.

HIV Counseling and Testing (HCT)

Of the 220 HCT clients whose forms

were reviewed 19.3% were males and

80.7% were females. A good number

(42.1%) had been previously tested

while 57.9% had never been tested

before. For the current HCT sessions

provided at Namulaba, 22.0% received

individual pre-rest counseling, 73.8%

received group pre-test counseling and

4.2% (8 people) were counseled as

couples. However, the data on marital

status, shows that 45.0% of the clients

were married which suggests the need

for increased effort at encouraging

couple counseling.

The majority of the clients (72.8%) had

ever had sex while 27.2% had never had

sex. Of those who had ever had sex,

77.3% said they had had sex in the past

six months and of these only 22.9%

said they knew the status of their

sexual partner. This data suggests theneed to encourage disclosure and

sexual partners to seek HCT and to

share knowledge of HIV status.

.

Medical Conditions Seen June -Nov

07

The most common medical condition

treated was malaria which comprised

30.0% of the diagnoses. Malaria is the

most common cause of fever and fever is

one of the commonest presenting

symptoms of HIV disease. Most malaria

in Uganda is resistant to the commonly

used drugs (Chloroquine or Fansidar).

Thanks to the support Namulaba

Health Centre is receiving from AVERT

we are able to provide the efficacious

malaria treatment using Artemesinin

Combination Therapy (ACT) as per

government policy. ACT is only available

in a few government facilities which areinaccessible to rural populations such

as Namulaba due to transport costs.

Following in order after malaria, is

respiratory tract infections which were

treated in 20.5% of the patients.

Cough is another major clinical feature

of HIV disease. It is also the main

presenting feature of pulmonary

tuberculosis whose incidence is

documented to be higher in people

living with HIV and AIDS. Patients

presenting with cough of more than

three weeks are referred to Kawolo

hospital for sputum examination andchest x-ray to exclude tuberculosis.

Next in order are peptic ulcers which

were seen in 9.8% of patients.

Dermatoses or skin lesions were seen in

9.1% of patients. Fungal skin infections

and other forms of rashes is a known

HIV and AIDS clinical feature. Next in


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order are intestinal worms diagnosed in

7.9% of the patients, pelvic

inflammatory disease in 7.4%,

hypertension diagnosed in 7.1%, joint

pains in 7.1% and urinary tract

infection in 5.9% of the patients.


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.

People Living with HIV and AIDS

The PHA support group is being led byMr. Aloysius Musisi who is a person

living with HIV and AIDS who has been

trained in HIV counseling by a number

of organizations including TASO, Mild

may Mission Hospital and the

International HIV and AIDS Alliance. He

is currently working part time at

Namulaba Health Centre as a counselor,

he also works at Kawolo Hospital as an

ARV counselor and he has also been

designated by the International HIV and

AIDS Alliance as a PHA Network

Support Agent (NSA).

The Waggala HIV support group

consists of PHAs who have been

recruited from individuals who were

either tested before Namulaba Health

Centre started offering services or those

who have learnt that they are HIV

positive from receiving HCT at

Namulaba. All those identified as

positive are referred to Mr. Musisi who

introduces to them the idea and offers

them to attend the Thursday PHA

support group. By Nov 07 the

membership has grown to 40 including

11 male and 19 female adults as well as

6 male and 4 female children under 18

years of age. Among these are two

Community Health Workers of

Namulaba Health Centre.

The Waggala HIV support group works

on creating awareness about ARVs

among PHAs, giving them information

about the availability of CD4 testing as well as ARVs at Kawolo and Jinja

Hospitals. They also explain how these

services can be accessed and where

possible escort fellow PHAs to seek

these services. They also provide

ongoing support to each other to ensure

ARV adherence and coping with living

with HIV and AIDS.

Religious Counseling The need for religious counseling was

identified at the very beginning during

the formative community seminars that

preceded the services of the Health

Centre. The community members were

of the view that one of the reasons HIV

had spread was the degeneration of

religious morals. The Parish Priest for

the Anglican Church has spearheaded

this area of work by making himself

available to provide religious counseling

on Thursdays when the PHA supportgroup meets at the Health Centre. In

the months of Aug to Nov he was able to

deliver this service to a total of 62

clients. He has also reached out to the

leaders of the other major religions in

the community and is preparing a

training meeting for them to take place

in January 2008. It is hoped that the

other religious leaders too will be

attracted to deliver this service to

clients of their faith.

CBO Network

In the formative phase of the project a

mapping of CBOs present in the

community was carried out. It was

observed that 22 CBOs of different

capacities were present in the

community but none or few of them had

managed to carry out any activities

owing to resource and capacity

constraints. It was decided that a


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Network of these CBOs would be

formed. On 21 July 2007 this network

was formed with 18 founding members

and it was officially registered with the

Government in August 2007. A

committee was elected and the Chair

Person is Mrs. Margaret Kizito who is

also the Speaker of the elected Local

Council of the sub-county. The CBO

Network committee meets every second

Saturday of the month. So far the

committee has successfully recruited a

team of Community Health Workers.

They have also resolved that they will

use the user fees collected at the clinic

to build a community pharmacy and

maternity building. So far they have

procured a building plan for this

structure. It is planned that the

Network is increasingly given

responsibility to manage the resources

provided to Namulaba Health Centre. So

far they have successfully managed and

accounted for the funds used to carry

out the Music Dance and Drama

competitions around World AIDS Day in

December 2007.

Community Health Workers

The Community Health Workers (CHW)

were selected among community

members by the CBO Network

Committee. The selection was based on

written applications submitted in

response to a community advertisement

put up by the CBO Network. The main

criteria used for selection was the

ability to understand English and

Luganda as well as previous training or

experience in community work. Twelve

were selected, two (one male and onefemale) per each of the six parishes of

the catchments area. Their training

comprises of a half-day

training/meeting on the second

Saturday of every month. It was started

in October and is expected to go on for

six months. In the four weeks before

they return for training, they carry out

two types of activities.

One is a hygiene survey and the other isthe provision of individual HIV

counseling in the community. The

training session is more or less a

meeting. It starts with a reporting and

discussing of the hygiene work and the

individual HIV counseling done in the

previous four weeks. This is followed by

a teaching/discussion on a chosen topic

and lastly a work plan is made for the

next four weeks.

The CHW are volunteers and they donot receive any salary for this work. But

they are given a transport refund for

coming to attend the training session

and for going to carry out the hygiene

surveys. They are also provided meals

for the two days they spend in the field

doing hygiene surveys each month. As a

way of motivating them, they have been

provided T-Shirts, bearing project logos,

and gum boots.

Hygiene Survey

This is carried out by the whole group

of CHW visiting one parish for two days

and going home to home assessing the

level of hygiene. On October 8th and 9th

the group visited Waggala Parish where

they reached 87 homes. Ventilation is a

major hygiene issue because a lack of

adequate ventilation increases the

chances of transmission of tuberculosis

among people in that house.

Tuberculosis is a major opportunistic

infection for people living with HIV and

AIDS. The CHWs found that in 46 of the

homes visited the residential houses

had adequate ventilation while in 22 it


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was not enough and in 15 there was no

ventilation at all. A good supply of clean

water is vital for reducing diarrhea

which is a major affliction of people

living with HIV and AIDS. The CHWs

found that in 71 of the homes the water

was collected from piped wells, in 6 it

was collected from a running river and

in 5 from a pond. They also found that

in 44 of the homes the drinking water

was boiled, in 3 it was filtered but in 33

of the homes nothing was done about

the drinking water. In the homes where

the CHWs find gaps in the level of

hygiene they educate heads of the

households about the need to meet the

hygiene standards and the CHWs go

back to check on improvements.In addition to helping to improve the

hygiene of people in the community the

hygiene work has emerged as an activity

that has helped the CHW to establish

their credibility as people concerned

about the health of the community. It is

the view of the CHWs that this will

function as a launching pad for their

AIDS specific work.

HIV counseling in the community:

The CHW are being trained to be able toengage community members and

discuss HIV and AIDS issues. In the

four weeks between the training

meetings they make attempts to engage

community members in HIV counseling.

They report these encounters during

the CHW training meeting and highlight

the challenges they met and other

CHWs together with the facilitators

discuss how to address these

challenges. For example, at the training

meeting of 17 Nov 07 a CHW reported

how she decided to visit a lady and her

daughter who was ill and yet they had

cut themselves off from the rest of the

community. She visited them and learnt

that while the older lady believed that

she had got HIV from her daughter, out

of nursing her, she did not want to go to

be tested. She discussed with them

about how to seek HIV testing. At thetraining meeting of 15 December

another CHW reported that he had used

his position in his church as the Youth

Pastor to engage young people to talk

about HIV and AIDS and to seek HIV

testing. He reported that his main

challenge was how to answer the

question on what happens to one after

testing positive for HIV. In the training

meeting of CHWs this issue was used to

launch into a discussion about whatCHWs should say with regard to

available services for HIV positive people

including ARVs at Kawolo and Jinja

Hospitals.

KABP Survey

In December 2005 a baseline survey of

HIV Knowledge, Attitudes, Behaviors

and Practices (KABP) was carried out.

This survey was repeated in Dec 2006and has also recently been conducted in

Dec 2007. The survey has

demonstrated a slight rise, between

2005 and 2006, in knowledge about

mother to child transmission, a rise in

those who mentioned condoms as a

means to protect from HIV but a fall in

those who mentioned abstinence or

faithfulness. In terms of reported

behavior there was a slight rise in those

who had abstained for more than a year

and those who reported condom use.

These interesting results will be further

compared to the Dec 2007 KABP survey

which is currently being analyzed.

Further to this, qualitative research

may be carried out to verify or clarify

the observed trends.


15

Documents

Namulaba Update Newsletter