Ugandan Health Facilities

             There are several different kinds of health facilities in Uganda – private and government and different levels of health centers (HC), which provide different services. The lowest level is a health center II and the highest, a health center IV, and then hospitals.  Health center II’s are usually found in more rural areas and provide out patient services, immunizations, health education, antenatal care.  There is no doctor on staff and they are usually run by nurses and nurse aids.  They do not perform deliveries and therefore pregnant women must go to a HC III, IV or hospital, depending on the level of care they need during delivery.  My HC is a level III and private; it operates under the parish and Kabale diocese, which has its pro’s and con’s.  As a level III, we provide both outpatient and inpatient services, immunizations, antenatal care, HIV services, deliveries and health education.  We have two outreaches in a month where we travel to hard to reach areas to provide antenatal care, immunizations, and HIV testing and counseling, as well as one immunization clinic in a month where mothers bring their babies for routine immunizations.  Being as we are under the catholic church, we do not provide any family planning methods at our HC and refer patients who are interested to government health facilities.  This is challenging because in a country with such a high birth rate, a typical woman gives birth to 7 children and at times is unable to afford school fees, shoes, clothing or nutritious food for these children.  Now compare this number with the global average of 2.7 and the African average of 5.1!  Many women don’t have the power to negotiate condom use, especially married women, as the husband can accuse her of being unfaithful.   Working for a private HC, however, has it’s pros including – usually more funding available and nicer resources than government facilities which makes many people choose going to a private facility over a government one for health services.  Unfortunately as a HC III, we do not have a doctor on staff and therefore cannot perform cesarean sections or surgeries.  We do have a theatre ready to use, but unfortunately it is very challenging to find a doctor who will live and stay outside of a big town for longer than 4 months.

            So, I have now been at my site for a little over 3 months and much of my time has been spent just getting to know people and learn more about my community.  This past Saturday, I went with some of my coworkers to the all girls secondary school in our community where we provided free, voluntary HIV testing and counseling.  I began by giving a health talk on the importance of testing and knowing your status, how HIV is transmitted and how you can prevent transmission.  This is a sensitive topic as is, and discussing it with young, shy Ugandan girls, I thought would be very difficult.  They surprised me, however, and asked many questions and were actively involved during the talk!  We tested nearly 200 girls and not one tested positive, which is amazing! It was a great day spent getting to know the girls and learning their interests, seeing their school and dormitories, and meeting some of the teachers who I will hopefully be able to work with in the future.  Im looking forward to spending a lot of time with the youth in my community because they are the future of this country!

Here are some statistics for Uganda that I thought might be interesting:

-       Population = 27.7 million (expected to increase to 130 million by 2050)

-       life expectancy = 58.7

-       7.3 % HIV prevalence (highest in central Africa)

-       number of people living with HIV = 1.5  million (est.)

-       population growth rate – 3.1% (world avg. 1.2%)

-       only 20% of married women between age 15-49 have access to contraception

Inside outpatient department

Patiently waiting to see sister..

Delivery Room

These yellow aprons and rain boots are the only thing midwives/nurses
wear to protect themselves during deliveries

Maternity ward

Family support group

Client files and ARV's stock room

My counterpart and best friend! - Fausta

ART clinic (for HIV+ Clients)

Out patient department

Sandra just bein herself

HIV Testing and counseling 

girls waiting for testing 

even the youngins' learned something!

these two kept me company all afternoon :)

My "sister", Cecilia, the daughter of Regina (one of the cooks for the church)

Prudence counseling

ART clinic 

Immunization clinic. Mothers waiting to have their babies weighed

Laboratory

Prudence, our midwife. Can you believe we are the same age?!

Sheila busy working

maaaaaany posters covering the walls of our HC...
my favorite = you mean you are not circumcised!