6/12/13
Meeting with the Bishop
“The Kikandwa Health Clinic aims to provide affordable and
accessible health services as well as educational programming to promote
longer, healthier lives and to reduce the prevalence of preventable illness.”
This was the statement we kept in mind today as we met with
Bishop James William Ssebaggala of the Mukono Diocese in Uganda. Conversation
had begun last January in terms of the Diocese’s potential involvement in the
running of the health clinic in the future. Today, the conversation today was
much more detailed.
The first topic of discussion regarded the Diocese’s current
position within the healthcare industry in Uganda. Within the past few years,
the Diocese has not only upgraded a local facility to hospital status, but has
also finished the process of opening it’s own nursing school in Kampala. The Diocese
also focuses on community outreach. This is done in order to educate the
surrounding community about the services they provide to people of all creeds
and walks of life.
Later on, we talked about the current and anticipated roles
of involved parties. From the Shining City Foundation with fiscal support, to
the potential role of the Diocese with the clinic’s operations, we discussed
each party individually. The role of the community was emphasized in the
conversation time and time again. It was very reassuring to hear this,
especially when community involvement is the reason rural clinics anywhere are
a sustainable success.
It was also amazing to hear of their desire for checks and
balances in whatever relationship occurs, possibly with a more formal
“constitution” of sorts with the clinic. This will certainly be kept in mind as
we continue to work these next few weeks on a Memorandum of Understanding
between the Diocese and the Drake students and faculty that are committed to
the creation of a sustainable health clinic in the village of Kikandwa.
I know I speak for the rest of us here when I say that we
are excited to be touring their hospital, nursing school, and a smaller medical
facility near Jinja (another major city of Uganda) tomorrow!
June 13th, 2013
Mukono Diocese Hospital
As we rolled up to the hospital operated by the Mukono
Diocese, we were unsure of what to expect. We had heard much about the
facility, its offered services, and the promises it has brought to the
surrounding community. How much of this held true? We met our host for the day,
Dr. Dixon, and could immediately tell from his passion and experience that we
would certainly have all our questions answered.
Right away, I was intrigued by the payment strategy of the
hospital. Doctor Dixon stated that they strongly believe in the “treat first
and pay second” mentality. “With this, we save more lives,” he said. He also
described their “Christian” attitude towards the fees for services. This meant
that the hospital often accepts lesser payments as reconciliation for their
debt for services. They often price discriminate with the patients that can pay
more versus less. However, this is not something uncommon in Uganda. Because of
the frequent bargaining with goods, taxi rides, and virtually all services,
those who can pay more are expected to do so.
I was also extremely impressed by the resourcefulness and
optimism of everyone there. Most of the medical equipment is at least ten years
outdated and less than optimal for providing care. However, this does nothing
but strengthen the commitment and passion of those who serve in the hospital.
They often say, “If we ever hear of someone throwing out broken and outdated
equipment, we tell them to send it our way. Because that equipment can be fixed
and used to say lives…it can be used to save lives.” That was a point he
emphasized on multiple occasions, and was much needed. As Americans, we are so
used to certain standards of care and operation in the U.S. However, it is
unrealistic for Uganda to have these same expectations and standards here. If
this were the case, care would rarely be found for those in search of it.
Better yet, car would rarely be found for those who need it. Ultimately, it was
a statement that always brought us back to reality and reminded us just how
many obstacles they overcome on a consistent basis in order to preserve life.
In the hospital, many improvements are looking to be made.
The unfortunate thing is that funds are always an issue. This is especially
true since their costs consume almost all of their revenues before taking
facility improvements and investments into account.
It was also today that I began to focus more on the reason I
am here: health education in rural Uganda. After some inquiry, I found that a difficulty
with healthcare in the area lies in a community wide misconception. This misconception
is in regards to medication and “good” medical treatment. For instance, the
hospital is often presented with a patient that has been taking a cocktail of
medications, claiming that they treat many different things, all prescribed by
local herbalists with self-proclaimed success of different remedies. When faced
with this situation, Dr. Dixon often has to use the wording that two
medications may be similar, but the hospital’s are “pure” and will work better.
This is just one example that shows that the development of any kind of health
curriculum, especially in a rural area, will have to combat various
misconceptions first in order to further local knowledge.
Finally, our day concluded with a visit to a Diocese-ran
health center in Jinja. After playing with quite possibly the cutest little
girl I have ever had the pleasure of meeting in my life, we toured the
facilities and met with multiple staff members there. The first observation
that could be made was the lack of patients. While this was a great thing to
see because it meant people did not require the services, it was disheartening with
the very little money flowing in. While talking to the staff, we’ve found that
many of them work without being paid the full contracted amount due to the
shortage of funds. This undoubtedly is impacted by the free medical hospital
nearby. Why go pay for a clinic when there are free services offered in a
nearby hospital? However, the staff has kept an extreme amount of faith that
the funds will come and continue to be able to help those in need. The
important question is whether or not this mindset is conducive for the
sustainability of the clinic. And that question can certainly be debated on for
a long time to come.
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