Uganda

{Photo credit: Rui Pires.}Photo credit: Rui Pires.

In the beginning of my medical career during the early 1990’s, I witnessed the devastating effects of HIV & AIDS.  Nearly 60 percent of the hospital beds I attended were filled with AIDS patients, many of them my close friends and colleagues. At the time, little was known about the AIDS epidemic; no effective treatments were available; and as a physician, I watched helplessly as day after day those closest to me suffered until their death.  

Today, almost three decades later, thanks to increased prevention and access to care and treatment for HIV, most of these hospital beds have emptied of HIV & AIDS patients.  Now, these same beds are filled by those suffering from preventable chronic diseases, including vaccine-preventable cancers.

Today, February 4, we commemorate World Cancer Day, joining the global community to raise awareness about the global cancer epidemic, and renew our commitment to address cancer in low-and middle-income countries (LMICs).

[A woman talks with Belkis Giorgis (right)] {Photo credit: Dominic Chavez, 2011}A woman talks with Belkis Giorgis (right)Photo credit: Dominic Chavez, 2011

Makasi after two months of tuberculosis treatment. {Photo credit: A. Massimba/MSH.}Photo credit: A. Massimba/MSH.

With less than 1000 days until the Millennium Development Goals expire, the process for setting post-2015 goals continues to ramp up.  We take this opportunity to reflect on the current state of community health systems in low- and middle-income countries and consider how the post-2015 agenda could reshape them—perhaps dramatically.

Community health systems today

Integration moves ahead

Poor and rural communities in low- and middle-income countries are leaving behind the “one clinic, one service” approach. So-called vertical programs, which organized resources according to single health conditions, created a patchwork of health services at the community level. You could get HIV care from one provider, but would have to go down the hall, down the street, or often much farther to get maternal health care or malaria care.

Patients wait in a well-ventilated area outside the TB clinic in Homa Bay, Kenya. {Photo credit: A. Kwiecien and A. Salakaia / MSH.}Photo credit: A. Kwiecien and A. Salakaia / MSH.

The state of tuberculosis (TB) is in a tug-of-war as current challenges threaten to undo past successes. One of the primary hurdles currently facing TB prevention and cure is the emergence of strains that are resistant to at least two of the most effective medicines (rifampicin and isoniazid).

So-called drug-resistant (DR)-TB arises when patients are unable to complete a full-course of appropriate, high quality anti-TB medicines. As compared with the 6 month treatment regimen for drug-sensitive (DS)-TB, DR-TB requires 18-24 months of treatment with medicines that are less effective, can cause sometimes severe side effects, and can cost up to 300 times more.

World TB Day celebration in Ghana (2012). {Photo credit: MSH.}Photo credit: MSH.

Sunday, March 24, 2013, is World TB Day, and MSH staff and partners are promoting global efforts to stop TB throughout the week.

Here are highlights from some of our activities around the world:

The Afghanistan TB CARE I team is working with the national TB program (NTP) to conduct celebration events at 290 health facilities and communities in 13 USAID-supported provinces. TB messages will be aired through local telephone companies to approximately one million people throughout the nation. TB CARE I is also identifying and publicly rewarding high-performing health workers.

The Bangladesh SIAPS TB team will participate in a national rally on March 24 with all TB partners and stakeholders within the NTP network, as well as in a press conference, workshop, and scientific session.

Celia Tusiime Kakande. {Photo: Tadeo Atuhura/MSH.}Photo: Tadeo Atuhura/MSH.

For most of my life, women in Uganda---as in most countries---were treated as inferior to men. Girls were less likely to be educated than their brothers, and had little control over the direction of their lives. Many girls grew up being told how to act, eat, and talk; many women were regarded as little more than domestic caregivers. However, in 1986 the ruling government radically changed the dynamics of Ugandan women in global development and their participation in decision-making at all levels of government. This International Women’s Day we, in Uganda, are celebrating this transformation with a theme of “connecting girls, inspiring futures,” and wishing women around the world similar progress and success.

Women Lead: Government

Women in Uganda now hold more leadership positions than ever before—35 percent of the seats in Parliament are now occupied by women, and our Speaker of Parliament and Minister of Health are women. The introduction of universal primary education has allowed more girls to begin their schooling, and affirmative action at the university level has provided more women the opportunity to realize their dreams for fulfilling professional careers.

Celia Tusiime Kakande. {Photo: Tadeo Atuhura/MSH.}Photo: Tadeo Atuhura/MSH.

For most of my life, women in Uganda---as in most countries---were treated as inferior to men. Girls were less likely to be educated than their brothers, and had little control over the direction of their lives. Many girls grew up being told how to act, eat, and talk; many women were regarded as little more than domestic caregivers. However, in 1986 the ruling government radically changed the dynamics of Ugandan women in global development and their participation in decision-making at all levels of government. This International Women’s Day we, in Uganda, are celebrating this transformation with a theme of “connecting girls, inspiring futures,” and wishing women around the world similar progress and success.

Women Lead: Government

Women in Uganda now hold more leadership positions than ever before—35 percent of the seats in Parliament are now occupied by women, and our Speaker of Parliament and Minister of Health are women. The introduction of universal primary education has allowed more girls to begin their schooling, and affirmative action at the university level has provided more women the opportunity to realize their dreams for fulfilling professional careers.

Mildred's Story: Treating HIV and Chronic Non-Communicable Diseases.Mildred's Story: Treating HIV and Chronic Non-Communicable Diseases.

Fact or fiction?

  • About 70% of all cancer deaths occur in low- and middle-income countries.
  • Nearly 30% of cancer deaths could be prevented.
  • Many cancers (such as breast, cervical and colorectal cancer) can be cured, if detected early and treated adequately.
  • Cancers are killing more people in developing countries than HIV & AIDS, malaria, and tuberculosis combined.

Answer? Fact. All of them are true.

Cancer is not only a disease of wealthy and elderly nations. The cancer burden on low- and middle-income countries is vast---and cancer deaths are projected to continue rising, with an estimated 13.1 million deaths in 2030. Living in poverty increases the risk of developing cancer, and dramatically reduces the odds of being treated. For example, 90% of child leukemia patients in the United States survive—but in developing countries, the opposite is true: nearly 90% die.

MSH: Saving lives and improving health in 2013.{Image credit: MSH.}Image credit: MSH.

We have seen some remarkable gains in global health in 2012. Yet millions of women, children, and men still die from preventable causes. As we pause and reflect on 2012 and look ahead to the new year, I invite you to read and share some of our favorite blog posts from the year.

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