Mengo Hospital

Hi all as most of you know I have been working at Mengo Hospital HIV clinic in Kampala, Uganda for the summer. The more time I spend her the more I am impressed with the work that Mengo is doing in their work with addressing the HIV epidemic within their country. Mengo tests and treats patient for HIV, but their job is not so simple as that. 1st to find patients, they test patients (with the patients consent) on all of the wards of the hospital for HIV- this is where they find many of they patients. Once a patient is confirmed as having positive HIV test they are given counseling and education about HIV and referrals to the HIV clinic, or a clinic that can assist them near their homes. Once a patient is confirmed HIV + the staff makes sure to follow up with the patient and have them come to the clinic. If patients have a high CD4 count, (the white blood cells that fight opportunistic diseases) they are monitored and placed on a medication called Septran ( an antibiotic that fights the opportunistic infection). HIV attacks a person's immune system so this is very important in maintaining the health of an HIV+ person. Patients are monitored until their CD4 count drops below 350 for women and 250 for men. This actually is quite low, in the U. S. treatment would start immediately if a person was detected to have HIV. This is because of the expense of ARV treatment (it is a very expensive treatment) and due to all kinds of drug patents etc... it remains expensive,even for those most needing it.

Mengo monitors these patients every month for complications and also monitors the CD4 count. Once the CD4 count drops to the low enough level they start the ARV treatment. They give patients a lot of education and counseling before they start the ARV treatment, and continue to monitor and educate once treatment has been started. Patients are to come in initially every month and monitored for their adherence to taking the ARV's, then every 2 months... If a patient stops taking their meds and then restarts they can become resistant to the medication, so this monitoring of adherence is very important.

Patients are also monitored for side effects, and opportunistic infections, nutrition and willingness to disclose their status to friends and family. If people disclose their status they are much more likely to maintain adherence to their drug regimen.

Mengo also tests pregnant women and makes sure the women will take ARV treatment if they are HIV positive (and also give the newborn ARV's) to prevent mother to child transmission of HIV. Much education is given in this area. Many children I have seen are on ARV's and are becoming healthy kids that can go to school and have a good life. Many of the children may have lost their parents and are living with older siblings or relatives or even neighbors and having HIV gives the child difficulty because of the stigma attached with having HIV. Mengo works with the caregivers in helping these children stay on their ARV's and deal with the stigma. Nutrition is also an issue with these families because it is important for HIV+ people to have good nutrition, but because of the poverty level, it is difficult for them to have enough food.

The clinic also does outreach testing, which means it goes out into the communities and tests people, so people dont have to make the trip to the clinic,which they often wont do because of stigma, money and time to travel to the clinic. Counseling is done right onsite.

They also do home based care and care for patients at home that are too sick to travel to the clinic. The doctor and a nurse and a counselor travel to the pateints home and may administer IV fluids and meds and give counseling to family and assistance as needed. A spiritual counselor will travel with the team also.

Education is given to the community in many ways also, several of the physicians travel to schools and give sexual and lifeskills training and inform the adolescents about prevention. I recently attended a workshop in which Mengo was teaching the police officers in Kampala about HIV and post exposure prophyaxis. This is a very important population to educate because they may be the first responders to a rape victim who needs PEP treatment or they themselves may need the treatment because they have been helping people in an accident that involves a lot of blood exposure.

What I have seen here at Mengo has been quite impressive, given the lack of resources. The staff is committed, caring and very knowledgable, I feel quite grateful to have this opportunity to learn from the real experts in this field.

Pictures are of HIV+ children that are recieving treatment at the support club, and HIV+ patient recieving home care, and Childrens ward at Mengo hospital

Rwanda

One of my co-workers and I had a 4 day week end and made the 8hr buss ride to Kigali, Rwanda for the week-end. On first impression Kigali is a beautiful city, - one of the most beautiful in Africa,it is clean,friendly and well organized. We decided we wanted to visit some of the memorials that were made in remembrance of the genocide that happened in 1994 between the Hutus and the Tutusis. Prior to visiting these memorials, I had not had much exposure to the genocide beyond watching "Hotel Rwanda."


We visited 2 catholic church memorial sites outside of Kigali and the Kigali memorial. I remember the movie being quite horrific, but actually visiting the memorial sites was truly sobering. Hutu's and Tutusi's used to live together, marry each other and were friends for a very long time... then in the late '50's with the help of Catholic missionaries and French, a separation of the two tribes became prevalent and people were required to Carry ID cards differentiating the two tribes. Tutsi's were generally more wealthy and more favored by the missionaries and governments. The Hutu's stirred by propaganda began small genocides on the Tutsi's in the late '50's,this continued until the largest one, which killed over 1 million of the * million people in Rwanda in 1994. People fled to the catholic churches for sanctuary, believing that they would not be killed if they were in a holy place. The Hutu's carried out brutal murders when they were killing the Tutsi's,torturing ,dismembering and raping victims before they killed them. In one small church that we visited over 1,000 people were killed inside the church and another larger church over 10,000 people were killed. Hand grenades were thrown into the church to break in and soldiers would get on the roof and shoot down into the crowd of people below. Once they broke into the church people were bludgeoned with clubs and machetes. Women were brutally raped over and over from men and with objects. Small children were slammed against brick walls. People, clubbed, but still alive were thrown down pit toilets on top of each other until they were smothered.


Our driver shared that he was a Tutsi and had escaped his village and hid in the swamp for 2 months. He had no idea what had happened to his family. He had nothing to eat for 2 months. When he learned that the killing had subsided he returned to his village, finding dead bodies covered with flies and dogs eating them everywhere. He found his mother and sister thrown into their pit latrine with their breast cut off.


The tail of genocide is horrific and the stories go on.. I could not help but cry in sadness and wonder why... ? The U.N. deserted Rwanda at this time stating that this was a tribal war and not wanting to get involved. It is estimated that it would have taken 500 troops to stop this slaughter. Paul Kegale-a Rwandan, led troops from Uganda to stop this madness, and was able to -3 months this went on. He has since become the president of Rwanda and has taken a strong stand in stopping the tribal tension. All of the ID cards were destroyed and it is now illegal to differentiate between Hutus and Tutsis- You can be thrown in jail for even suggesting this. The government is mixed and al efforts are made to integrate the two tribes for peace. On the outside Rwanda looks like it is moving forward and beyond the horrific past. Many suggest not enough greiving has been done or was allowed...


The other part of Rwanda that we saw was the 5 volcanoes Park, which is home to Dianne Fossey the woman who studied and lived with the gorillas. We went past where she was buried and her favorite silver back gorilla Digit,buried near her. It turns out we were about 500 meters from a family of gorillas but they would not let us see them, as it costs $500 USD t see them and they try to limit the numbers of people to 48 per day who see the gorilla's for 1 hr! Oh well, very interesting to be in that area. It is truly a very beautiful place and my friend Anand and I climbed to the top of a volcano instead and looked into the crate lake it had formed.

in Kampala

Hi all, Well I have arrived safely in Kampala and now have been here over 1 week. We spent a couple days orienting t the Global Health Fellowship Program in Washington D.C. before we left to Kampala (this was my first time to D.C.,so I was impressed. As I have stated before - I am thrilled for the opportunity with GHFP and am looking forward to learnig tons.

I have now worked 5 days at Mengo Clinic- in Kampala. I am truly impressed with the work they are doing. The clinic serves over 5,000 HIV positive patients and sees approximately 200 patients a day. They do counseling.testing and ARV administration and management of symptoms of people on treatment. They do an excellent job with counseling HIV positive patients and working with the patients to make sure they adhere to treatment. There is much ongoing education and support groups for the patients, so they can maintain thier treatment. Many patients still suffer from stigma, poverty and lack of support. The people who work at the clinic are outgoing, positive and very supportive of their patients and welcoming to me- a newcomer.... am sure I will learn tons from them.

In Uganda, people must wait until their CD4 count is below 250 (which is quite low) before they can go on treatment- this is because of funding... There simply is not enough funding to treat all of the HIV + patients, so they let the CD4 count drop quite low before putting patients on treatment. Much of the funding comes from Pepfar grants supplied by the U.S.

I am learning to navigate the taxi system here in Kampala... It is difficult,crowded and dirty- traffic is as bad as in India- with 6 rows of cars jammed up -trying to drive in 2 lanes of road and every one beeping their horns, yelling and running over pedestrians,with motorcycles and bicycles trying to pass between vehicles that are too close together. To find your combi (the 16 paseenger vehicle in which they pack 18-20) you must risk your life dodging between cars and trying to squeeze between combis that are backing up or moving forward-with no regards to people walking between at all. On top of trying to navigate in an area in which you dont speak Lugandan, and people are yelling "muzungu!!!"-which means white person..and trying to overcharge you for the fare..... Ahhhh welcome back to Africa- This taxi rank is much more difficult,conjested and dirty than any have been in in South Africa or Lesotho!!!