Blog Posts by Margaret Hartley

A tray of supplies, including household vinegar, used for screening patients. Masufu Hospital, Uganda. {Photo credit: M. Miller/MSH.}Photo credit: M. Miller/MSH.

Using a basic household item like vinegar to screen for a deadly disease is one of those "Aha!" solutions that will save lives. I had never imagined that I’d get to see the procedure in action.

Cervical cancer kills some 250,000 women every year -- over 80 percent from low-income countries, according to the World Health Organization (WHO). Early diagnosis can save lives, but many health facilities in developing countries struggle to find a way to screen women in remote, overcrowded settings. Last year, The New York Times talked about the success of using vinegar as a cervical cancer diagnostic method in Thailand, and yesterday SHOTS, NPR's health blog documented its life-saving use in Botswana.

Jessica, David, and Matuet are members of the community, HIV-positive clients, and a key to HIV care and treatment at Masafu Hospital. {Photo credit: M. Hartley/MSH.}Photo credit: M. Hartley/MSH.

I visited Masafu Hospital in eastern Uganda on a busy Tuesday morning. Tuesdays are antiretroviral therapy (ART) clinic days at this Ugandan facility. Patients come on their designated date for a checkup and to pick up their prescription refill. (Clients get a one month supply of medicines; ideally health workers see the HIV-positive clients once a month to check their health status.)

Three volunteer expert clients --- Jessica, David, and Matuet --- assist the trained health workers on clinic and non-clinic days.

On ART-clinic days, Jessica, David and Matuet organize files, greet patients, inform patients about side effects, educate on prevention methods, support CD4 collection, and communicate with relatives. On non-clinic days, the expert clients reach out to the communities to reduce stigma, inform people about the services available at health centers, and encourage others to know their status.

David explains that he chose to become an expert client because, “I have the challenge too; I want to help others understand HIV better.”

Matuet said, “Other community members don’t want to know their status. I had to stand up.”

Anna outside Kaginima Hospital, eastern Uganda. {Photo credit: M. Hartley/MSH.}Photo credit: M. Hartley/MSH.

“I knew I wanted to be a nurse since I was 10. A woman used to come home to my village in her nurse uniform on the weekends and she was so smart and nice. It was my goal,” said Anna.

Anna finished nursing school and her formal training in 1998 and started working in 1999. In 2000, she began working at Kaginima Hospital in eastern Uganda, where she still works today.

Kaginima Hospital is an expanding facility and uniquely has a lot of space for patients and services. The facility has a surgical theater with two beds and is well stocked with medical supplies. As a private, nonprofit hospital, Kaginima does not receive any support from the Ugandan government. The hospital relies on support from USAID, international organizations, faith-based organizations, and local nongovernmental organizations. They also charge nominal fees for the services directly to patients.

Sophia is now the go-to person for family planning and reproductive health services at Rwesande health center IV in western Uganda. {Photo credit: M. Hartley/MSH.}Photo credit: M. Hartley/MSH.

Sophia is a humble woman. She has been working as a nurse for 10 years, and is currently one of five nurses posted at Rwesande health center IV in the hills of western Uganda.

When I arrived I was impressed by the number of services the health center offers, and the general appreciation felt around the compound. Rwesande health center IV has a maternity ward to safely deliver babies; counseling areas for family planning, reproductive health, and HIV; a general ward, a surgery theater, and health education space.

Family planning counseling and services now available

As Sophia shows me her meticulously-kept record books I can see the pride she takes in her work. She explained how women are now coming and asking for family planning services.

Not too long ago clients were not coming, and the nurses didn’t have proper training on methods to offer clients.

Ezekiel Kyasesa, village health team coordinator in western Uganda. {Photo credit: Margaret Hartley/MSH.}Photo credit: Margaret Hartley/MSH.

Ezekiel Kyasesa is a village health team coordinator and supervisor in Kasese District, western Uganda. He supports 11 villages, 90 parishes, and 2 health centers.

Ezekiel has been working in community health for a few years, but only on a small scale. A year ago, he was selected to attend a training provided by STRIDES for Family Health to learn new family planning, child survival, and reproductive health information and the skills to become a village health team member. He was then nominated by his peers to become the coordinator and supervisor.

Now Ezekiel is educated and has the skills to go out to the communities and talk to people about the benefits of going to the health center for a range of services. The village health teams are a crucial link to sharing knowledge and information between the clinics and the communities.

Ezekiel and his village health team visit 10 households two days each week (20 visits per team member each week). He explained that they discuss with the mothers --- the key person to a healthy family --- four topics:

(Left to right) Aaron Musiimenta, assistant regional behavior change communication officer; Tadeo Atuhura, STRIDES for Family Health communications specialist; Dr. Baseka Yusuf, district health officer; and Kevin Kisembo, principal nursing officer and STRIDES focal person. Kasese, Uganda. {Photo credit: Margaret Hartley/MSH.}Photo credit: Margaret Hartley/MSH.

The Kasese district in western Uganda is nestled between two national parks. Located hours from the capital city, Kampala, the region attracts tourists to view gorillas and mountain birds.

During my recent trip to Uganda, I met with Dr. Yusuf Baseka, the district health officer of Kasese, who described the health challenges his district faces, and his hopes for the future.

Although the national parks are beautiful and bring a much needed economic boost to the area, they also offer a challenge, Dr. Baseka explained.  The population growth and fertility rate of the district are very high. With the two national parks, there is no land for expansion. The town of Kasese is rapidly becoming a slum with unsanitary conditions that are difficult to address.

Another challenge in his district is that children are not going to or staying in school. They are leaving secondary school early and engaging in risky sexual behaviors. He explains, “We’ve seen a dramatic increase in young mothers, under 18 years, some as young as 12.” Their pregnancies offer unique challenges for the health system to address.

Mbambu, a midwife at a western Ugandan health center. {Photo credit: MSH.}Photo credit: MSH.

Mbambu is a midwife who works at Isole Health Center III in rural Western Uganda. When I had the opportunity to visit with her, she was the only health care provider at the center. Trained as a midwife nine years ago, her passion for her job pours out of her. Since primary school, becoming a midwife "was always my mission,” she said.

A little over a year ago, Mbambu was trained in family planning and reproductive health skills by STRIDES for Family Health, a USAID-funded program in Uganda led by MSH. Prior to the training, the health center could only offer education and basic family planning services.

Now Mbambu educates women who are waiting to have their children immunized or receive antenatal treatment about family planning, healthy spacing and timing of pregnancies, and the benefits of delivering at a health center. Her new skills also empower her to administer basic and long-term family planning services.

Mbambu shared a compelling story that I promised I would share with others:

Women learning about family planning at Bikone Health Center II, Western Uganda. {Photo credit: MSH.}Photo credit: MSH.

This was my first trip to Africa working with a development agency. While I had visited the African continent for personal trips previously, arriving in this context felt different. I was immediately aware of the challenges Uganda is facing. From the crumbling road infrastructure and high incidence of traffic accidents in Kampala, to the mobile phone networks that are pretty reliable while internet access is often spotty, to the prevalence of street children --- I can for the first time see what my local colleagues are up against.

I felt a bit overwhelmed in the first few days. Is there any way we can address all these challenges? Can we make a difference?

Visiting communities and health centers in Kampala, Eastern and Western Uganda -- and seeing first-hand the impact MSH is having across the country -- quickly re-inspired me.

I had the pleasure of meeting a particularly passionate and committed Clinical Officer, Rodger Rwehandika, at Bikone Health Center II in Western Uganda. As a health center II, Bikone is an outpatient facility, but the staff of the facility can also conduct outreach programs to educate and serve the community.

Rodger and his two staff facilitate health education programs at the local schools and also host youth-friendly programs on using condoms.

Last week, the United Nations Commission on Population and Development (CPD) met in their 44th session to negotiate next steps on a resolution for fertility, reproductive health, and development.  The Commission helps inform the United Nations (UN) on their global efforts and provides crucial recommendations to form UN Resolutions.

MSH, with over 80 partners and advocacy organizations, sent an open letter to the delegates of the 44th session. Together, we called on the Commission on Population and Development to:

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