Bewyale Uganda Panyandoli Health Clinic

Mr. Charles Naku, Country Coordinator, Uganda November 29, 2009 

The upgrade of the Panyadoli Health Centre has changed the community's perception of the health centre and as a result, over the course of the year, the number of patients visiting the health centre has increased.  

In addition to the facilities upgrade, RMF has already started playing a crucial role in support of the clinic's health care delivery by bridging government funding gaps. Recently, in a joint effort with the UNHCR, Real Medicine Foundation purchased much needed malaria medicine for the clinic, which ran out due to the increase in cases of malaria during the current rainy season. 

While our homeopathic malaria program addresses as much as one third of the cases, the spike in malaria cases at the Panyandoli health center quickly depleted the stores of medications for those wishing to be treated at the center.

Real Medicine's John Njorge and the Kenyan settlement leader Peter Karanja oversaw the supplies being offloaded while Dr. Richard verified the new inventory.  All parties confirmed placement within the clinic's storage room.

Not only did the rains strain medicine inventories but also wards and grounds needed additional attention and the local government had no budget to hire staff to keep the clinic maintained. In response, RMF quickly stepped in and provided funding to increase the staff of ward cleaners and grounds keepers to keeps the wards mud free and the tall grasses within the compound cut during the heavy rains. 

Maintaining hygiene is paramount to the delivery of proper care and the tall grasses often deter community members from visiting for fear of snakes. Some of the many patients are even tempted to defecate in the tall grass rather than going to the latrine.

At present, the wards are well maintained and free of mud and debris.  Pictured below are the women and children's wards.  The mosquito nets have been removed for cleaning and drying during the day and are returned in the afternoon.

Below is the maternity ward with RMF mosquito net, blanket, and mattress and photograph of the ward ceiling, which has been recently painted.

The ward buildings have been all been cleared of the bush. The photograph below shows the conditions prior to the RMF staff of groundskeepers and difference afterward in contrast.

Because of the increased hygiene on the compound, the laboratory, pictured above right and below has become the location for ARV program and counseling.  Below shows the interior of the lab.

Update June 2009

Clinical officers at Panyadoli Health Clinic with donated mattresses.

Refugee community cleaning Health Clinic Grounds.

Country Coordinator, Charles Naku and leaders at the Kiryandongo Refugee Settlement orchestrated the painting of bed frames and the interior and exterior of all the wards at the health clinic.  Gallons of white and green paint were purchased taking into consideration Masindi Ministry of Health’s color scheme preference.  Many of the refugees along with the chief clinical officer had prior painting experience.  Rather than hiring from the outside RMF employed those inside the settlement to upgrade the Panyadoli Health Clinic with fresh coats of paint.  Mattresses were purchased to cover the bare bed frames and replace the torn, soiled unhygienic mattresses. Covers for the mattresses are being sewn by refugees so that the mattresses will be protected and remain clean.  Above the bed frames mosquito nets were hung to decrease the chance of contracting malaria.  Cleaning supplies were purchased to maintain hygienic conditions at the clinic and the grounds were slashed to remove overgrown bush.  A sense of pride and enthusiasm has surrounded the upgrade of the health clinic.  Patients and community members have voiced their gratitude for the attention the health clinic is receiving.

Wards after painting:

This is the gate entrance of the Panyadoli health center after painting

Update March 2009
Bewyale Uganda Panyandoli Health Clinic Upgrade
By Michael Lear, Director International Relations

• Malaria*
• Respiratory Infections
• Intestinal Worms
• Sexually Transmitted Disease (HIV/AIDS)
• Trauma/Domestic Violence
• Psychological Trauma (PTSD)*

* RMF is currently supplementing Health Center Support through its Homeopathic Malaria and Acupuncture Programs based within the Refugee Settlement. At the time of this report there were no cases of Malaria at the Health Center. This is quite unusual according to village residents.

• In/out patient services
• Health education - Protecting families with HIV - Family planning
• Health Team field visits for Health Education
• Specialized Dr. comes generally once a week

We greatly appreciate the scope of your needs to better serve the community and the time you have taken to prepare and convey them to us. Our intent is to first address areas of priority that directly impact the hygiene of the center and the quality of care being provided to the community, which you have estimated at over 16,000 including Ugandan IDP’s and Kenyan and Sudanese refugees.

Medical Supplies: The list below is not a comprehensive list of the Health Centers needs.

Medicine – We are aware that you obtain medicine from the government every 2 months and from the UNHCR every three. Real Medicine will serve as a third source to bridge any gaps in delivery from your primary sources so that the center is never without necessary or emergency medicines.

We will also provide the following medical instruments to facilitate more thorough intakes and assessments of the patients. Fulfillment of all items will depend on our available funding.

• Baby Scale
• Adult Scale with Columns
• Stethoscope – Children’s
• Stethoscope – Adults
• Thermometers
• Digital blood pressure cuffs
• Digital blood pressure gauges
• Examinations Equipment – reflex hammers, tongue depressors, etc
• Ears Nose and Throat Kits
• BTL Set, STS Set, DNC Set
• Implant Insertion Kits: Trocha and Camilla (please confirm this information)
• Dressings and Antiseptics
• Soaps and Disinfectants

All equipment purchased by RMF will be identified with our logo and/or as “Property of Real Medicine Foundation” on the unit itself and maintained in a separate capital equipment inventory. These items are not to be removed from the center for any reason unless authorized by RMF project coordinator, Mr. Charles Naku.

Health Management Information Systems: HMIS

To upgrade the data maintenance at the facility, RMF will purchase a computer with MS Office and a printer. This will also improve the ease and timeliness of report generation required by RMF and its donors, The Ugandan MOH, and the UNHCR. The Health Center will provide RMF with at least monthly morbidity and mortality reports via email and hard copy, based on the UNHCR HIS v1. 4.00. The Health Clinic will clear with the UNHCR that they are authorized to furnish RMF with this file. RMF will address information sharing in the MOU.

Real Medicine Foundation will provide salary support directly to a selected trainee to apprentice under Michael to learn the computer based data Health Management and reporting system of the Panyandoli Health Center to prevent a gap in efficiency in his absence or in the event of his transfer.

Some stationary, pens, office supplies, markers, folders, filing and storage/filing cabinets will also be provided. The permanent items (computer, printer, cables, and cabinets will be marked with the RMF Logo and/or as “Property of Real Medicine Foundation” on the unit itself and when possible maintained in a separate capital equipment inventory. These items are not to be removed from the center for any reason unless authorized by RMF project coordinator, Mr. Charles Naku.

Facility Upgrade Implementation:

Rain Water Collections:

RMF will purchase gutters for the In/Outpatient and Antenatal buildings and place a plastic container between the two buildings to collect water. The tank will have both the Real Medicine Foundation and World Children’s Fund Logos on it.

Electricity/Power:

It is the intent of RMF to assist in providing a solution in part or entirely to the power needs of the core activities of the Health Center. We have considered Solar Power, Generators and having the electric lines run to the Health Center. The method of resolution is not yet decided.

Inquiries are pending on the electrical requirements of the facility. Mr. Simon Opieto is contacting a technician for this assessment. He will advise Michael Lear, RMF of the determination (electrical requirements/ward/building). The technician will also project costs to bring the phone line to the Health Center, including pole costs and laying the wire.

Solar Power

Mr. Francis Semwoge of the UNHCR explained that GTZ has already done a comprehensive needs assessment for solar power. He is currently trying to obtain this report. RMF will contact GTZ and inquire about partnering to facilitate the installation of solar power jointly.

Gas Generators

Gas generators are costly to operate long term. However they can be an effective method of providing short durations of energy if necessary. The current generator provided by the UNHCR is adequate for operating a computer and perhaps a printer. RMF will provide a fuel allowance for operating the generator in this capacity. The amount is yet to be determined.

The specific areas of support will be outlined below and coordinated with our Project Manager, Mr. Charles Naku. You may also speak directly with Mrs. Beth Cole, our Ugandan Country Director or contact me directly. Your assistance in obtaining information about expenses is greatly appreciated.

Structural Upgrade of the Facility:

Real Medicine Foundation will provide paint and supplies for interiors of each ward including:

* Mattress quantities are based on maximum patients per ward during high admittance months//through the rainy seasons often related to malaria as estimated by Mr. Michael, following an assessment of in patient history.
** Sheet sets are for parents who were unable to bring sets or do not have sets for stay at center. (Sheet/Cover/Blanket)
*** Spray Paint if possible

Please note that the above figures are initial estimates and are subject change.

Notes:

We have quoted white paint for the walls and are looking for quantities of blue for the window and doors. We are aware that some of the ceilings will also require minor repairs and we can support this as well. (In particular there seems to be a roof leak in the antenatal ward.) Again, if there are refugees willing to volunteer their time we will facilitate this through Peter Karajna, camp leader.

Charles Naku our Project Coordinator will procure the supplies necessary to clean each ward, and paint the interior walls and interior doors in white and blue respectively. Cleaning supplies will be marked as RMF property and kept on hand in each ward for regular cleaning.

Notes Cont’d:

The children’s crib beds will also be painted, approximately 15. There are a number of broken crib beds and beds in each ward. We suggest these be move out of the wards into storage if they can be repaired or disposed of if irreparable.

With the reduction of crib beds in the children’s ward we suggest to bring in 4-6 adult beds for the parents who stay with the children.

• An inventory of existing mattresses that are in very good condition should be taken. Any damaged or torn mattresses should be removed from the wards and stored.
• Some of the window netting of the wards are torn. An inquiry needs to be made about screen costs to repair.
• Our intent with removing unused or damaged beds is to create an open and clean appearance.
• We recommend Hygiene education follow the cleaning and painting – i.e. cleaning feet before entering.

Malnutrition Ward Support:

Quotes for kitchen structures to support the malnutrition ward and other wards will be obtained and RMF will provide – the former is most important and will be constructed first. A secondary structure may be built if funding is available. Some cooking ware may be provided. Cleaning supplies, detergents, etc will also be supplied.

If funding is available Real Medicine Foundation may be able to offer support to rebuild the fallen structure in this area.