Uganda

A tray of supplies, including household vinegar, used for screening patients. Masufu Hospital, Uganda. {Photo credit: M. Miller/MSH.}Photo credit: M. Miller/MSH.

Using a basic household item like vinegar to screen for a deadly disease is one of those "Aha!" solutions that will save lives. I had never imagined that I’d get to see the procedure in action.

Cervical cancer kills some 250,000 women every year -- over 80 percent from low-income countries, according to the World Health Organization (WHO). Early diagnosis can save lives, but many health facilities in developing countries struggle to find a way to screen women in remote, overcrowded settings. Last year, The New York Times talked about the success of using vinegar as a cervical cancer diagnostic method in Thailand, and yesterday SHOTS, NPR's health blog documented its life-saving use in Botswana.

Uganda. {Photo credit: Paydos/MSH.}Photo credit: Paydos/MSH.

The Ugandan government launched a new prevention of mother-to-child HIV transmission (PMTCT) strategy on September 12.

Uganda will transition from an approach based on the World Health Organization's (WHO) Option A --- which is contingent on an HIV-positive pregnant woman’s CD4 count --- to WHO's newest PMTCT strategy, Option B+.

Option B+ — whereby HIV-positive pregnant women receive lifelong treatment, regardless of their CD4 levels — originated in 2010 when the Malawian government decided to combine antiretroviral therapy (ART) with PMTCT in response to the challenges of providing reliable CD4 testing in remote settings.

The WHO updated its PMTCT guidelines with Option B+ in April of this year.

Doreen Nalweyiso happily holding her twins. {Photo credit: T. Athura/MSH.}Photo credit: T. Athura/MSH.

In July 2011, Doreen Nalweyiso, a 27-year-old woman living in Mpigi Town Council, Uganda attended her second antenatal visit at Mpigi Health Centre IV. She was surprised to be examined with an ultrasound machine--and even more shocked to be told that she was expecting twins!

“I was thrilled when the nurse showed me images of twins through the ultrasound TV scan. I had never experienced it in my lifetime,” she explained.

This was her first pregnancy and there was no history of twins in her family. Because carrying multiple fetuses can cause complications for both the mother and babies, Doreen received support from the health center throughout her pregnancy.

Since she knew her delivery could be complicated, Doreen traveled to Mpigi health facility to deliver by caesarian section.

If she hadn’t known she was carrying twins, Doreen might not have known to seek out specialized medical care during labor and delivery.

Jessica, David, and Matuet are members of the community, HIV-positive clients, and a key to HIV care and treatment at Masafu Hospital. {Photo credit: M. Hartley/MSH.}Photo credit: M. Hartley/MSH.

I visited Masafu Hospital in eastern Uganda on a busy Tuesday morning. Tuesdays are antiretroviral therapy (ART) clinic days at this Ugandan facility. Patients come on their designated date for a checkup and to pick up their prescription refill. (Clients get a one month supply of medicines; ideally health workers see the HIV-positive clients once a month to check their health status.)

Three volunteer expert clients --- Jessica, David, and Matuet --- assist the trained health workers on clinic and non-clinic days.

On ART-clinic days, Jessica, David and Matuet organize files, greet patients, inform patients about side effects, educate on prevention methods, support CD4 collection, and communicate with relatives. On non-clinic days, the expert clients reach out to the communities to reduce stigma, inform people about the services available at health centers, and encourage others to know their status.

David explains that he chose to become an expert client because, “I have the challenge too; I want to help others understand HIV better.”

Matuet said, “Other community members don’t want to know their status. I had to stand up.”

Anna outside Kaginima Hospital, eastern Uganda. {Photo credit: M. Hartley/MSH.}Photo credit: M. Hartley/MSH.

“I knew I wanted to be a nurse since I was 10. A woman used to come home to my village in her nurse uniform on the weekends and she was so smart and nice. It was my goal,” said Anna.

Anna finished nursing school and her formal training in 1998 and started working in 1999. In 2000, she began working at Kaginima Hospital in eastern Uganda, where she still works today.

Kaginima Hospital is an expanding facility and uniquely has a lot of space for patients and services. The facility has a surgical theater with two beds and is well stocked with medical supplies. As a private, nonprofit hospital, Kaginima does not receive any support from the Ugandan government. The hospital relies on support from USAID, international organizations, faith-based organizations, and local nongovernmental organizations. They also charge nominal fees for the services directly to patients.

Sophia is now the go-to person for family planning and reproductive health services at Rwesande health center IV in western Uganda. {Photo credit: M. Hartley/MSH.}Photo credit: M. Hartley/MSH.

Sophia is a humble woman. She has been working as a nurse for 10 years, and is currently one of five nurses posted at Rwesande health center IV in the hills of western Uganda.

When I arrived I was impressed by the number of services the health center offers, and the general appreciation felt around the compound. Rwesande health center IV has a maternity ward to safely deliver babies; counseling areas for family planning, reproductive health, and HIV; a general ward, a surgery theater, and health education space.

Family planning counseling and services now available

As Sophia shows me her meticulously-kept record books I can see the pride she takes in her work. She explained how women are now coming and asking for family planning services.

Not too long ago clients were not coming, and the nurses didn’t have proper training on methods to offer clients.

Three women gather outside a Tanzanian health center. {Photo credit: M. Paydos/MSH.}Photo credit: M. Paydos/MSH.

The 65th World Health Assembly is convening this week in Geneva, beginning May 21. For six days, the Assembly will focus the world’s attention on chronic non-communicable diseases (NCDs), universal health coverage, mental disorders, nutrition and adolescent pregnancy, among other health issues.

This is the second time in less than a year that chronic NCDs --- such as cancer, cardiovascular disease, diabetes and lung diseases --- are in the international spotlight. Last fall, the High Level Summit on Non-Communicable Diseases convened in New York, when, for only the second time in the history of the United Nations, a high level summit focused on a global health concern.

Honor your mother, support healthy moms, and help kids reach their 5th birthdays: click the image to donate {Photo credit: MSH.}Photo credit: MSH.

Improving Child Health in Communities and at Home, the April/May 2012 edition of MSH's Global Health Impact newsletter (subscribe), features personal stories about child survival and child health in developing countries.

"Prevention, treatment and care close to the home are keys to saving children's lives," says Dr. Jonathan D. Quick, MSH president & chief executive officer, who blogs about saving children's lives through interventions closer to home, shares his 5th birthday picture, and encourages us to support USAID's 5th Birthday Campaign.

Stories about child survival and child health

The newsletter highlights a number of compelling stories from the Democratic Republic of the Congo, Uganda, Nigeria, and Lesotho.

Ezekiel Kyasesa, village health team coordinator in western Uganda. {Photo credit: Margaret Hartley/MSH.}Photo credit: Margaret Hartley/MSH.

Ezekiel Kyasesa is a village health team coordinator and supervisor in Kasese District, western Uganda. He supports 11 villages, 90 parishes, and 2 health centers.

Ezekiel has been working in community health for a few years, but only on a small scale. A year ago, he was selected to attend a training provided by STRIDES for Family Health to learn new family planning, child survival, and reproductive health information and the skills to become a village health team member. He was then nominated by his peers to become the coordinator and supervisor.

Now Ezekiel is educated and has the skills to go out to the communities and talk to people about the benefits of going to the health center for a range of services. The village health teams are a crucial link to sharing knowledge and information between the clinics and the communities.

Ezekiel and his village health team visit 10 households two days each week (20 visits per team member each week). He explained that they discuss with the mothers --- the key person to a healthy family --- four topics:

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