Together, for better
medical care in East Africa

Report from Uganda May 2018


Although we witnessed several emergencies during our last visits to Uganda, the visit in May was relaxed and very organized. Our new station administrator, Florence Sewava, picked me up from the airport and had prepared everything to perfection! She had equipped the newly rented station with many important items. I had brought three fully packed emergency backpacks and a large bag with ECG machines and small items. However, all this is still not enough.


Many preparations had to be made

Together with Florence, I spent the first days packing medicine and equipment in emergency bags, reserve backpacks and emergency vehicles and stocked up on medical supplies. There was much she didn't know because it wasn't available or popular in Uganda. However, she should be able to perform these tasks by herself in the future. The office also had to be set up and the computer, printer and Internet needed to be connected. However, she had already made the first guestroom for visiting doctors. To avoid unnecessary measures, I supervised the repairs of the vehicles.


Our vehicle pool is growing

We now had a useable multi-purpose vehicle and a fully equipped emergency vehicle we could use as a mobile doctor's office in remote villages. The vehicle has a small tent, a bench, a table, a power generator, an extensive selection of medicine and diagnostics technology on board. This is the first prototype of this multi-functional vehicle whose equipment we are regularly optimizing. We will soon equip another vehicle of this type. Providing mobile medical care in villages is one of the most important steps on our path towards free basic care in Uganda. We also have to recruit doctors for our long-term services for this project.


Valuable new arrivals

An emergency vehicle we had converted and equipped with additional technology in Germany for the special requirements of Uganda would arrive from Germany in a few weeks. Only LED lights, bull bars and off-road tires are significantly cheaper in Uganda. We negotiated about three additional ambulances with a dealer in Kampala.

In Hamburg, three emergency vehicles and an HLF 16 from a fire brigade, fully equipped and with protective gear for twenty firefighters, were waiting for their journey to Uganda. However, for vehicles weighing more than 5 tons, this is not as easy as one might think.


Cooperation with hospitals is difficult

Discussions still needed to be held with various clinics to determine the best options for the tasks that we could not yet perform through our own funds. We quickly learned that not many clinics were able to do this with the quality we expected and on the short notice we needed. However, we discovered that samples could be transported more quickly on boda bodas than through our multi-purpose vehicle, despite its siren. Discussions on the further training of the police and of public clinical staff are also necessary. Many doctors and clinics do not want to admit their shortcomings. This requires sometimes time-consuming persuasion.


The bureaucracy has no overview of the real conditions on site

For ministry employees, it often is not easy to find out what is going on. On paper, many hospitals seem well-equipped. But looking at the situation on site reveals that equipment has been broken or removed since long ago.

Therefore, hospital conditions are often assessed incorrectly. In some cases, we had to visit the ministry and show videos of the actual situation at these hospitals for them to understand that something needed to be done. But help is then accepted.


Corruption is common practice in Uganda

Maintaining contacts with various government representatives who always assume we were planning to exert political or economic influence was another time-consuming factor. Generally, our concept for the establishment of free basic medical care and a centrally-coordinated national emergency service at no cost to poorer citizens is received well.

Our refinancing concept is also met with agreement. Unfortunately, many past attempts by various organizations to obtain funding and tax exemptions through fraudulent means have created an atmosphere of mistrust towards foreign organizations that must be overcome. Uganda's bureaucracy is therefore very much like Germany's.


Continuing education is initially viewed with suspicion by doctors

Questioning medical qualifications quickly leads to "bad blood," especially at larger hospitals. It takes a lot of time and many examples of misjudgments to convince these doctors to attend our further training seminars. But once the ice is broken, the cooperation is most productive.

Our visit to the Makere police led to an interesting contact with the local training officer of the Makere University which we hope to expand and provide with interesting offers. Even if the need for training still exceeds our teachers' capacities, we are still trying to find a way to meet this challenge.


The situation on the streets in difficult

The city of Kampala is incredibly crowded. Getting stuck in traffic for four or five hours is not uncommon. Street vendors help pass the time. We were unwillingly confronted with the situation of street children in Kampala. Helping is not easy. The reasons will be discussed in detail elsewhere.

We hope that the collaboration with UNICEF will be fruitful and that we will soon find offers for foster families. Drugs are still of secondary importance, but it is probably only a matter of time before that will change. Every evening, we brought approx. fifty small lunch packages. When our vehicle arrived at a certain crossing in Kampala, you only had to tap on the siren and everyone came to get one of these packages.


Support for regional hospitals

We spent a lot of time on appointments for insurance and paperwork. This also needs to be done, even if we would rather drive out to the villages. We also visited the emergency room of the Mulago Hospital. This is the largest public hospital in Kampala.

Although construction work was taking place, one cannot overlook that everything is lacking. A lot works, but much also ends in chaos! We wanted to try to provide an additional doctor and a rescue assistant every day. The need for supplies exceeds our capacities, but we will find a solution.

We still had to discuss the modalities with the hospital administration. A number of bureaucratic obstacles needed to be overcome. During every visit, the nurses "raided" our emergency vehicle. But even when filling it to the brim, this was a drop in the bucket!

Supplies for the Mpigi Hospital would be sent from Hamburg soon. We were far from obtaining all of the long list of equipment for the Mpigi Hospital, but the next container would be sure to include several boxes for Mpigi. I had a new ECG machine packed for the Kamwenge Health Center that I handed to the chief physician and instructed the staff to use.


Operations in the surrounding areas demand a lot from our vehicles

During the last week of my stay, I visited the station in Kamwenge. This required an approx. 4-hour drive on the Fort Portal Road to Kyenjojo followed by 3 more hours on the dirt road to Kahunge from where we took the Fort Portal-Mbarara Road to Kamwenge. 30 km of small unpaved roads until I reached the remote village of our colleague Alice.

Normally, many of these roads are only used by boda bodas. Navigation with a large off-road vehicle is a real challenge. Even though this seems doable in dry weather, rain can change everything and demand a lot from tires and one's driving skills!


Not only the medical situation is problematic

Alice's father is the village school principal. It was important to him to show me the school and tell me about local issues. Our visit showed that there is a need for action everywhere in Uganda. I will try to find a partner school in Germany that can help with this school's development. Working on all levels exceeds our capacities.

When I spent the night at Alice's parents' home, we started setting up the mobile office at dawn. As soon as the first rays of sunlight appeared on the horizon, a long line of persons from the surrounding areas seeking help began to form. Alice's mother served us breakfast before we started our work. The lack of electricity or drinking water reveals the true Uganda and one begins to understand the lives of its people. The simple things we Europeans take for granted determine the people's day.

We could hardly say good-bye for the meeting with our colleagues at the Kamwenge Health Center around noon. The line of people seeking help exceeded one hundred meters. When we returned, we turned on our power generator for light and we worked until the last person was treated.

We had been expected in Kamwenge. Unfortunately, I was only able to bring small and light equipment onto the aircraft. The rest had to be sent to Uganda via container.

We arrived with the eagerly awaited ECG monitor replacement machine for the operation and brought many small things, such as stethoscopes, pulse oximeters, SAM splints and tourniquets. Again, this was only a small step for this gigantic task! We hurriedly found our way back to the village where we would provide our mobile office for only two more days.


Serious accidents are daily routine

On the evening of the second day, it was time to return before the darkness made the road too difficult to navigate. Several kilometers behind Kahunge, we received a call from our station informing us about a serious traffic accident on the road from Mpanga to Kamwenge. A woman was run over by a truck. We quickly determined that the site of the accident was more than 20 kilometers away. Only part of the road was paved. Nearly half was unpaved mud.

Our off-road vehicle and tires really shine on special signal drives outside of streets and allow us to go really fast! When we arrived at the site of the accident, dusk had also arrived and we considered ourselves fortunate to have our accident site lighting system! We learned that a second vehicle was involved in the accident whose driver was stuck, but did not suffer any serious injuries. Two police officers used our hydraulic spreader to open the door and rescue the man.


Reanimation is rarely succesful

The woman was unconscious and hardly breathing. She was about 25 years old, had lost a lot of blood and was probably bleeding internally. Except for cuts, our examination discovered various broken ribs, a collarbone fracture, a fractured forearm and a larger soft tissue injury on her left thigh for which we could not rule out a fracture. Despite two Ringer's and HAES infusions, her circulation stopped.

Cardiac arrest following trauma is always problematic and often leads to the patient's death, even in Europe. Our vehicle was equipped with two biphasic defibrillators. Fortunately, after administering medication and fast infusions, our second reanimation was successful. A miracle in Uganda. The bystanders were stunned! In Uganda, defibrillators are essentially unknown and only available at a handful of clinics. Finally, we could hear the sound of the siren of the ambulance called from Fort Portal.


Our help does not only saves lives, but existences

Two days later, I learned that the woman's husband called to say the woman was alright. However, the man was anguished. He had heard that two emergency vehicles and a doctor treated his wife at the accident site. He had no idea how to pay for the hospital or the emergency services. One year ago, he had broken his leg in a work accident. This had cost him all of his savings and forced him to sell his car.

The man was stunned when I explained that Kilimanjaro emergency vehicle services are free! Most medicine came from our vehicle and Kilimanjaro Doctors would pay for the ambulance and the hospital. This example demonstrates the aim of our association. We try not to let accidents turn into an entire family's financial ruin!


Our efforts are bearing fuits

This was pleasant confirmation of our updated vehicle equipment and loading concept. This allowed our multi-purpose vehicle to serve as a mobile doctor's office, pharmacy and ambulance and provide technical accident assistance without changing staff or supplies!

Currently, our greatest task consists of training enough multipliers. For this, we need experienced doctors and teachers who are able to stay in Uganda for several weeks or months.