Annual Activity Report 2019

Uganda, "The pearl of Africa" many problems only become apparent on closer inspection 

The year 2019 was marked by organisational and logistical tasks. Our first vehicle import of the Mercedes Vito from the previous year kept us busy for a long time. It made us feel the full extent of the omnipresent corruption in the countries involved all too clearly. We learnt that European standards are no good here and that if you don't want to be completely exploited, you have to be much tougher than we are used to. Both the accident of the Honda CRV 10/05 at the beginning of the year and the lack of an emergency vehicle for our Ugandan training doctor made new purchases absolutely necessary. The lack of functioning vehicles adapted to the needs of the mission is one of the biggest problems in the logistics of the health system in these countries.

VEHICLE- AND SPARE PART PROCUREMENT ARE STILL PROBLEMATIC

It still seems to be problematic to understand what requirements await us in African countries. If you consider that in Germany, the purchase of a second-hand, fully equipped ambulance normally costs about 65,000 Euros and the purchase of a new one costs about 180,000 Euros, then it becomes clear that we have still acted very economically, despite all the obstacles and taxes. On the one hand, it is much cheaper and quicker to procure used vehicles locally and to upgrade them in Uganda. On the other hand, the used vehicles in Uganda are full of surprises, even for well-qualified technicians. All too often, not a single cent has been invested in the vehicles for years and there is a huge backlog of repairs. Ultimately, therefore, every purchase decision has to be weighed carefully. Unfortunately, the performance and knowledge of most mechanics in Uganda is more than very modest. Thus, a lot of time has to be invested in workshop visits. Often a repair becomes a never-ending story. Nevertheless, the costs are not even half of the import costs. Many problems only arise because the work is not done properly.

You have to be very careful that the condition of the used spare parts supplied is not worse than that of the old parts you have just removed. If you buy new parts, they are usually deceptively genuine-looking China or Korea duplicates with a short service life. So they are not a promising alternative either. We try to limit ourselves to four vehicle models in order to build up a few spare parts stocks. As car spare parts are heavy, bringing them from Germany on the plane is an option that only comes into question for a small part of the required parts. Unfortunately, the majority of mechanics do not work very neatly or cleanly, so it is essential to have a "security guard" with appropriate motor vehicle knowledge next to the vehicle during the entire repair time to prevent worse. Unfortunately, there is no guarantee of work done in Uganda, as we know it from Germany. If a repaired vehicle breaks down again the next day, the mechanic just shrugs his shoulders and says: "These things happen!

All this costs us a lot of time and money, but unfortunately there is no alternative at this moment. Experimenting with seven different workshops that are considered "good" in Uganda did not reveal any significant differences. None of them met our expectations. If we think about this problem, we understand a little better why so many vehicles in Uganda, which are actually good and worth repairing, are left unrepaired. In the upcoming year, we will try to create the conditions at our new location near Kampala to carry out part of the necessary maintenance and repairs ourselves in order to reduce consequential damage caused by a lack of expertise. We hope that this measure will lead to a significant reduction in repair costs. This in turn confronts us with the task of procuring or introducing professional tools.

Borrowing medical equipment proves to be an efficient strategy

The strategy we tested for the first time right at the beginning of our work - not donating rescue vehicles and equipment to hospitals or health stations, but simply lending them to them with qualified staff and keeping the maintenance and care in their own hands - seems to work much more successfully than previous variants such as donating them to a clinic or hospital, as practised by various organisations.

In autumn, we had the opportunity to see the sad remains of various rescue vehicles and equipment donated from Europe in recent years. Sustainable development aid must look quite different! Once again, it became very clear how important it is to modify, adapt and regularly maintain vehicles that are to be used in Africa. Apparently, this does not work at all if it is done by the local services themselves!

Rescue vehicles must also be suitable for severe weather conditions

It is a very good idea to also equip rescue vehicles with hydraulic tools such as spreaders and cut-off machines, which are lacking all over the country. We, too, strive to have these things loaded on all our vehicles as far as our cargo resources allow. But it is also a great pity when emergency vehicles cannot reach the scene of an accident because they are not equipped for rough roads and have unsuitable tyres. This should also be taken into account in the preparation. We also think, that the variant of some hospitals, not to send their vehicles to emergencies and accidents at night or in heavy rain, is not a good idea. Our vehicles always move, even during demonstrations, conflicts or pandemics! We at Kilimanjaro Doctors try to use only four-wheel drive vehicles. The European road tyres are immediately removed after the vehicles arrive in Uganda and exchanged for larger off-road tyres with all-terrain or mud-terrain treads. 

Depending on their model, the vehicles are raised between 12 and 40 centimetres, equipped with locking differentials, all-round ram protection, additional air filters and additional headlights. This enables our vehicles to reach the emergency scene at any time of day or night and in any weather, even in severe weather conditions. In many cases, our vehicles also serve as an example of innovation and inspiration for equipping or retrofitting one's own vehicles along these lines. Supplied with this equipment, our vehicles can reach the emergency scene even in heavy rain, darkness or floods. All our Landcruiser emergency vehicles are equipped for water crossings of up to one metre in depth and can also reach areas cut off from supplies after severe weather.

In November, for instance, after a storm, one of our emergency vehicles was able to rescue a lorry with 69 people. The vehicle, which had suffered engine failure in the middle of a raging river, was able to be retrieved from the over 1 metre deep, very fast-flowing water and all the travellers were brought to shore safely. A hypothermic baby was subsequently given emergency medical care. All other passengers were well and could continue on their way. Two emergency vehicles from the Kampala site were involved. So far, Uganda does not have any special vehicles equipped for such rescues.

The vehicle equipment has to fit

We have finally succeeded this year in equipping all vehicles with two to three fire extinguishers for initial response and human rescue. In the coming year, we also want to equip the emergency ambulances and rescue vehicles with a complete set of hydraulic rescue equipment, generators, vacuum mattresses and cut-off grinders, and not just the fire engines. We now stock about three hundred medicines in sufficient quantities on the vehicles and have all medical equipment on board at least twice. This means that equipment not available at the target hospital can remain with the patient for as long as medically necessary.

We have patient medication boxes on board, which are filled with the acute medication for the transported patient for the next three days, which remain with the patient. We have found, that often the necessary medication is not available or can only be obtained after days. Sometimes there is simply no money available. However, the purchase of emergency medication cannot be postponed.

With the help of the government and other organisations, successful against "would-be doctors"

This year has once again shown us very clearly how inadequate the qualifications and experience of many doctors and nurses are. In one hospital we found that none of the three doctors present knew how to re-position a broken leg bone. In another hospital, one doctor did not know the symptoms of typhoid fever and another could not do a trauma examination after a road accident. One more did not know how to give first aid to a stroke patient. In part, these are certainly gaps in knowledge, albeit very large ones, which can be filled - but in part, many diplomas are simply forgeries, which explains why some "doctors" simply have no idea about medicine at all.

These documents are far too easy to obtain in Uganda and are of astonishingly good quality. Such bogus doctors must be consistently removed from the system! After reviewing our field reports with professors from the Ministry of Health in Uganda, we have jointly come to the conclusion that we presently have to assume about 30 % are forgeries or even more. There is currently a need for action to protect the population from self-proclaimed " wannabe doctors". In many meetings with government representatives, university medical lecturers, representatives of the Ministry of Health and the Crime Investigation Unit of the Uganda Police, we have developed a verification system for people working in the health sector!

A separate and independent department of the Ministry of Health, the new Quality Management Department, has been appointed by the authorities to carry out these controls. Such a big step against corruption and forgery has never been taken before in Uganda.

We have developed a two-phase audit. To check the diplomas, we have worked with computer specialists to develop a new software with an app for the quality managers of the Ministry of Health, with which all data, qualifications and diplomas of a person are now recorded nationwide and made accessible to the ministry staff. In a second step, experienced doctors and instructors check the practical skills of the doctors and nurses in a sort of practical exam. Documents can be faked, but skills and know-how cannot! We see this project as a milestone in the development of the Ugandan health system. The entire project planning, development and implementation was carried out and completely paid for by Kilimanjaro Doctors.

Progress in 2019 and prospects for 2020/2021

This year, Kilimanjaro Doctors is again providing emergency medical services and ambulance services around the clock over the Christmas holidays. All other services remain closed. This year, there were significantly fewer patients treated directly by us, but all the more misdiagnoses and mistreatments detected. We also made good progress in developing our logistics this year.

Our emergency medicine service is working very successfully and is one of our main fields of activity. We hope to be able to support its operation with another vehicle in the upcoming year, as we are still far from covering the demand. However, an expansion is currently limited by our budget.

In the coming year, we will continue to develop and expand the radio network created with the support of the company Wittkowski Funktechnik. Radio communication has a significant time advantage over telephone communication.

We are still very concerned about the issue of safety. At the turn of the year, we will now equip all vehicles with live interior and exterior cameras and active GPS trackers. While not all vehicles have a narcotics safe yet, all will have a Taser on board after the second attack on one of our vehicles. A central remote shutdown for vehicle engines in case of theft is in the pipeline. Stations are now getting better night vision cameras and larger surveillance monitors after more thefts and attempted thefts occured. Our lighting system with motion sensor-controlled LED headlights is being expanded and supplemented by two german shepherd dogs. Our security is getting night vision devices and infrared scopes on the firearms.

We hope to be able to put an ultrasound and an X-ray machine into operation on both wards in the upcoming year.

Kamwenge station is pleased to have our first fire engine with portable pump trailer. It is the only operational fire-fighting vehicle within a radius of 80 km. The vehicle is a second-hand one from Germany, but we have equipped it with the most modern fire-fighting technology and technical auxiliary equipment. In addition to a full-time fire fighter, we will initially train six volunteers to operate the fire brigade there. More "fire and rescue" stations are to be added in the following year.

It is becoming more and more apparent that we can hardly manage the tasks on our own. Therefore, we hope to find some qualified and active comrades-in-arms in the new year!