“Sister, what do you mean?” I asked.
Sister Jane had just arrived at our home after a 22 hour journey from rural Uganda on a three city visit to meet with American donors and suppliers to her small hospital. She looked around the kitchen. “In Uganda, we only have what we can use. Why do you need all of this?”
Now most of you know that Randi and I are not extravagant people, but at that moment as I followed Sister’s gaze I was suddenly embarrassed by our modest sized kitchen, twice the size of a mud hut that would house an entire Ugandan extended family. “If there is no use for it, we don’t have it”, she said in her calm voice as she took another sip of tea. I now understood why Sister arrived at JFK in only her thin cotton habit and sandals despite my warnings of record cold and serial snowstorms. And living in a country where less than 5 percent of the rural population has access to electricity, even our simple toaster must have seemed an extravagance to her at that moment.
Sr. Jane was here to discuss what she did need, bare necessities to provide basic medical services to the quarter of a million people her hospital serves, as well as a chance to see for herself the healthcare systems that Randi and I had tried to describe during our past visits to Uganda. Uganda’s rural health system is not primitive, but in many ways decades behind where we are in western medicine. But the Ugandans are ambitious to move quickly to a more modern system that will provide higher quality and more efficient care to their population.
Randi and I established “Palliative Care For Uganda, Inc.”, a non-profit organization to provide medical and administrative expertise, staff education, and medical supplies to rural Uganda with particular attention to improving quality of life and amelioration of suffering in the acute and chronically ill. And with the help of generous donations, we are seeing the growth of programs.
Some examples of PCU’s work to date:
Naggalama Children’s Benevolent Fund – No child shall be refused treatment because of their family’s inability to pay. In a country where no insurance, government or otherwise, exists, many children don’t have access to lifesaving treatments due to lack of money. Since the establishment of this fund by Palliative Care for Uganda, several children have received care, and at very little cost. For example, a weeklong hospitalization including IV antibiotics for a life threatening illness often costs less than $50 total, but many families would not bring their children in due to cost concerns. Now they come and the children are treated successfully.
Hospital Rooms Upgrade – Six bedded rooms are the norm in Ugandan hospitals, affording no privacy. With funds from Palliative Care for Uganda, simple curtains on hanging rods were installed in some of these multi-bedded wards to encircle each bed to allow the patients privacy during their stay; a low-tech intervention making the healing process much more humane.
Palliative Care Outreach – Many people in need of medical care can’t make it to the clinics or hospital. We have discovered that there are countless people, mostly subsistence farmers not counted in any government statistics, outside the villages and cities that have no access to healthcare. The Palliative Care Outreach team, consisting of a nurse, a nurse assistant, and a pastoral care provider with support and training from Palliative Care For Uganda now go out to the villages and beyond to attend to the acutely ill and chronically infirmed, young and old, to treat their illnesses and ameliorate their symptoms in their own homes. When necessary, they are transported to the hospital for inpatient care.
Medications and Supplies – In the past, we have partnered with Americares to bring in medications to Naggalama Hospital and the Palliative Care Outreach team. However, all of these supplies must be hand carried in our luggage from Connecticut to Uganda which limits the amount that can be brought. With donated funds, Palliative Care for Uganda is now able to purchase medications and supplies from the Ugandan government suppliers so they are obtainable throughout the year and without transportation costs. There are no overhead charges for this or any of the other programs sponsored by PCU, all money directly used for programs.
Educational Programs for Staff - Since the establishment of PCU, two continuing medical education programs in palliative care have been held for the hospital staff on the grounds of the hospital and several more are being planned to bring the latest medical knowledge to the doctors and nurses there. Through this education, systems have been implemented to improve palliative care for hospitalized patients with relief of their suffering during treatments or for the chronically ill to reduce their discomfort.
Coordination of Care with the Villages
Meetings are ongoing with several of the surrounding village health teams and community health workers to make them aware of the services now available through Naggalama Hospital and the Palliative Care Outreach Program. Feedback has been excellent.
Internet and Wi-Fi
Despite several obstacles to bringing consistent and dependable internet to the hospital in its rural location, we are finally seeing some progress toward partnering with a telecom company in Uganda to bring internet and information technology to Naggalama Hospital. This is a major priority for PCU as it will greatly enhance staff education and development and has the potential for bringing state of the art medical care through telemedicine and internet based learning and communication.
Of course, there is always much more that needs to be done. The current number of trained medical staff is inadequate, the physical facility is far from able to handle the needs of the community, the chronic lack of medications and supplies, and inadequate modes of transportation to get staff out into the villages or patients back to the hospital; all are impediments to basic quality healthcare. Randi and I are addressing all of these needs and working on ways to mitigate these obstacles to better healthcare.
During her visit, when we took Sr. Jane for a tour of Norwalk Hospital, it wasn’t the state-of-the-art CAT scanner, the computerized medication carts, or the flat screen TVs in the single bedded rooms that amazed her. “Look at that. Linens on every bed!” she exclaimed. Randi and I recalled that in Ugandan hospitals, if you want linens on your bed your family must bring them, and even launder them by hand during your stay. Thinking back to sitting in our kitchen, and Sister stating simply, “We don’t have what we don’t need” I realized that we take for granted even the simple things that are needed and we promised Sister that we would provide her with linens.