MakCHSA Students' Medical Outreach to Kaabong district: a project report

ABSTRACT

Kaabong district is found in northern Uganda in Karamoja subregion. The district headquarters are at Kaabong town, about 155 kilometers from Moroto, the largest town in the sub region. Kidepo Valley National Park is found in the district. The majority of the population is comprised of nomadic pastoralists. The people of the district are among the poorest in the country (MSF, 2011) and 70% cannot access proper health care with women and children being the most affected. Health services in the district are provided by one government hospital and nine health centers and non-governmental Organizations (NGOs). The district has only one general hospital which is headed by a doctor who also doubles as the Medical Superintendent.

Kaabong district is a hard-to-reach area with a large population that has limited access to medical care and screening due to lack of resources and health professionals in the area.

Objectives

General Objectives

To increase awareness about HIV, UTIÔÇÖs and STIÔÇÖs, diabetes, hypertension, cervical cancer and general health of the people of Kaabong district.

Specific Objectives

1.      To screen for CVD├ö├ç├ûS, breast and cervical cancer, diabetes, STI├ö├ç├ûs, Hepatitis B and HIV and dental caries.

2.      To refer patients with chronic illnesses for further management

3.      To treat people with malaria, STI├ö├ç├ûs, UTI├ö├ç├ûs and other common venereal illnesses.

4.      To educate the people about family planning practices.

5.      To educate people about control, spread and treatment of chronic diseases such as diabetes, hypertension, and HIV.

6.      To educate people about proper nutrition and food security

This medical camp was to address some of the peopleÔÇÖs problems like lack of basic medicines and also to open up this area to the many health science students who would be encouraged to go and work there upon graduation from Makerere University. The screening tests were to also provide data that can be used for research on the prevalence of diseases like diabetes, hypertension in the area.

The programme was carried out at Kaabong Hospital from 20th-23rd of December 2014 after the closure of the semester. This camp was held in collaboration with Kaabong Hospital staff and Kaabong District Health Committee headed by the DHO.

This medical outreach was highly successful bearing in mind that we had a huge turn up of people and attended to almost everyone. In addition all the drugs we had brought were used and some remained.

The hospital is challenged by lack of human resource. We would recommend that government and all stake holders should invest in the man power.

INTRODUCTION

Kaabong district is found in northern Uganda in Karamoja subregion. It is bordered by South Sudan in the northwest, The Republic of Kenya to the north-east, Moroto district to the southwest, Kotido district to the south and Kitgum District to the west. The district headquarters are at Kaabong town, about 155 kilometers from Moroto, the largest town in the sub region.

Kaabong district has one county Dodoth that is divided into Kaabong town council and thirteen sub-counties. It is a rocky area with bushland and scrub as the main vegetation. Kidepo Valley National Park is found in the district.

Between 2002 and 2012, the annual population growth rate of the district was calculated at 7%. In 2012, the population was estimated to be 395,200 (UBOS, 2012). The majority of the population is comprised of nomadic pastoralists. The people of the district are among the poorest in the country (MSF, 2011) and 70% cannot access proper health care. Women and children are most especially affected with the maternal mortality rate (MMR) in the district at 760 in contrast to the national MMR of 432 per 100,000 live births. The infant mortality rate in Karamoja is 105 compared to 76 per 1000 live births nationally.

Health services in the district are provided by government facilities and non-governmental Organizations (NGOs). The district boasts of only one general (district) hospital, Kaabong Hospital and about nine health centers. The hospital is headed by one doctor who also doubles as the Medical Superintendent. This implies that he does both clinical and administrative work which reduces his ability to attend to patients fully. Access to health care (8km) is 10% (national average is 49%). As of 2009, the doctor-patient ratio was 1: 79,150. According to Kaabong hospital outpatient department documents dysentery, malaria, upper respiratory tract infections, trachoma, diarrheal diseases, worm infestation, malnutrition and pneumonia are some of the ten commonest causes of morbidity in the district. Non-infective gastrointestinal disorders, oral diseases, Urinary Tract Infections, Sexually Transmitted Infections also greatly abound in the district. Severe malnutrition, low weight for age and injuries due to violence are very prevalent.

Only two facilities offer PMTCT services. The HIV prevalence is estimated at 0.11% though disaggregated data by subcounty is not available. This calls for a district-wide HIV screening. Contraceptive use is very low in the district and condoms are the commonest form of contraception in the area. By 2009, there were no licensed drug shops in the district and this can only be detrimental.

Concerning immunization coverage, the district is trailing other parts of the country by 28% with a coverage of 57% compared a national coverage of 85%. Sanitation is poor in the district with a latrine coverage of 4.7% in 2009 (national is 100%) and limited access to safe water.

A number on NGOs have held medical outreaches in Kaabong district. These include Medicens Sans Frontieres (MSF), MercyCorps and USAIDÔÇÖs SUSTAIN Project. These organizations and outreaches like ours contribute a lot to the health-care in the district.

Problem statement

Kaabong district is a hard-to-reach area with a large population that has limited access to medical care and screening. The main reasons are the remoteness of the area, lack of drugs and a limited number of health professionals in the area.

The screening rates of diabetes, cervical cancer, hypertension, STIÔÇÖs and especially HIV are very low partly because of the above reasons but also few initiatives have been directed to this area because of its distance from the city where most initiatives are conducted.

There is no proper data in this area that highlights the plight of the people from Kaabong and Karamoja region.

With this in mind we conducted an outreach to the district with the aim of attending to some of the districts challenges.

Justification

This medical camp was to address some of the peopleÔÇÖs problems like lack of basic medicines and enlighten the people about their underlying health challenges.

This activity was also aiming to open up this area to the many health science students who would be encouraged to go and work there upon graduation from Makerere University.

The screening tests were to also provide data that can be used for research on the prevalence of diseases like diabetes, hypertension in the area.

This activity also gave medical students an opportunity to practice what they had learnt with the supervision of the senior members of the team and thus improved their understanding of what is taught in class.

Objectives

General Objectives

To increase awareness about HIV, UTIÔÇÖs and STIÔÇÖs, diabetes, hypertension, cervical cancer and general health of the people of Kaabong district.

Specific Objectives

7.      To screen for CVD├ö├ç├ûS, breast and cervical cancer, diabetes, STI├ö├ç├ûs, Hepatitis B and HIV and dental caries.

8.      To refer patients with chronic illnesses for further management

9.      To treat people with malaria, STI├ö├ç├ûs, UTI├ö├ç├ûs and other common venereal illnesses.

10.  To educate the people about family planning practices.

11.  To educate people about control, spread and treatment of chronic diseases such as diabetes, hypertension, and HIV.

12.  To educate people about proper nutrition and food security

ACTIVITIES

The programme was carried out at Kaabong Hospital from 20th-23rd of December 2014 after the closure of the semester. This camp was held in collaboration with Kaabong Hospital staff and Kaabong District Health Committee headed by the DHO. The activities were scheduled to take place for two days and then the students were taken for a trip to Kidepo Valley National Park.

On Monday 22nd we held the outreach day which started at 9.00am and ended at 6.00pm. The services provided included

1.      Cardiovascular disease (CVD) Risk assessment which includes: Blood pressure measurement, screening for diabetes, weight and height measurement, Body Mass Index and Waist-Hip Ratio to determine abdominal fat. Interpretation of the results was also done

2.      Cervical cancer screening using Visual Inspection with Acetic acid (VIA) was done by the senior medical students together with the hospital staff.

3.      Health education of healthy lifestyles, nutrition, family planning and other health topics was done.

4.      The people who had diseases were attended to, investigated and drugs were given to them. Those who could not be managed from the camp were referred, admitted or told to return at a later date.

5.      Dental check-ups, tooth extractions and referrals were done by our team from School of Dentistry, Mulago.

6.      Provision of condoms and contraceptive counselling was done.

7.      Donation to Kaabong Hospital. The drugs and equipment that remained after the camp were donated to the hospital. This included antimalarials (Lonart), lancets, gloves, acetic acid, cotton, 20 tins of cotrimoxazole (septrin) and many others.

8.      Some of the students carried out ward rounds with the doctors that were available. This was aimed at attending to those patients who had not been seen by the doctor-in-charge.

FINDINGS AND LESSONS LEARNT

The camp was held for two days and the following is some of the records.

Screening for diseases

A total of 315 patients turned up for this service. The following diseases were screened for:

1.      Hypertension

2.      Diabetes

3.      Cervical cancer screening

4.      Dental carries

Hypertension results

20% of the people screened had hypertension while 57% had a low blood pressure.

Malaria: A low prevalence of malaria was found as shown in the figure below whereby 99% of the people presenting with malaria-like symptoms were negative. Screening for malaria was done using the rapid diagnostic test kits

Cervical cancer screening:

Of those screened for cancer of the cervix, 11% had a result suggestive of the cancer or its precancerous conditions

Common diseases diagnosed:

Infections like malaria, diarrheal diseases, sexually transmitted diseases and urinary tract infections were the commonest health problems.

LIMITATIONS

Language barrier posed a challenge, however this was mitigated by availability of translators (VHTÔÇÖs).

The area is very hard to reach place, we spent about 18 hours on the road and the team was very exhausted to work early morning the next day.

Lack of enough equipmentÔÇÖs like malarial test kits, glucose test kits, some specific drugs like antibiotics, which posed a challenge to the progress of the camp.

Poor publicity in the area which led to few patient turn up on day 1 of the event, however this was also due to cultures like praying until evening on that day which was a Sunday.

CONCLUSION

This medical outreach was highly successful bearing in mind that we had a huge turn up of people and attended to almost everyone. In addition all the drugs we had brought were used and some remained. We believe that the impact of this activity on the lives of the people of Kaabong was immense.

RECOMMENDATIONS

Kaabong district hospital is a well-equipped center with an ultra sound machine and x-ray machine however it has no staff to man the equipment, we would recommend that government and all stake holders should invest in the man power.

Due to lack of doctors in the place (only the Medical Superintendant), training and motivation of health workers to work in Kaabong district should be done to curb this problem.

The main health problems identified corresponded to poor hygiene in the area especially improper fecal disposal. All efforts to sensitize the community about this problem should be done.

The government of Uganda and NGOs working in Kaabong and Karamoja sub-region at large should encourage more medical outreaches to the region. This will impact on the challenges of long distance, shortage of health workers and drug supplies.

We highly recommend that members of VHTs be greatly involved in such activities as they will contribute greatly to the success of such programs.

REFERENCES

Higher Local Governments Statistical Abstract, Kaabong district. June 2009

http://www.citypopulation.de/php/uganda-admin.php?adm2id=063

Medicens Sans Frontieres (MSF). Uganda: Suffering from chronic neglect in Kaabong. May 2011. http://www.doctorswithoutborders.org/news-stories/field-news/uganda-suffering-chronic-neglect-kaabong [Accessed on 1st October 2014]

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