Community Linkages: Saving Lives in Kampala, Uganda, One Patient at a Time

 {Photo credit: Diana Tumuhairwe/MSH}Musingire Annania (right) has successfully battled TB with the help of Paul Sebale (left), his community linkage facilitator.Photo credit: Diana Tumuhairwe/MSH

This is the story of Musingire Anania, a 45-year-old, small-scale laundromat owner from the slums of Mulago in Kampala District, Uganda, who has successfully battled tuberculosis (TB) through the dedicated efforts of his community linkage facilitator, Mr. Paul Sebale, and an example of how community linkages can help a TB patient at the brink of death to start and complete treatment and be fully cured.

Annania’s ordeal began in December 2014:

I had coughed for more than two weeks. I was as small as a string of thread. If it were not for Musawo [health worker] Paul, I had decided to bid the world farewell. I had conceded defeat.

Community linkage facilitators, such as Sebale (Musawo Paul), are trained social workers under the TB model of care implemented by the US Agency for International Development (USAID)-funded, Management Sciences for Health (MSH)-led TRACK TB project, through the AIDS Information Center and the Kampala Capital City Authority.

Annania attributes his health -- and life -- to Musawo Paul:

I had always heard about people talk about TB on the radio. I looked out for the TB signs but I had none that I could distinctly identify. I got to the point where I vomited nearly a full basin of blood. I was convinced that I was possibly vomiting out my liver or pancreas or even my heart. That scared me the most. It’s at that point that I knew I should go to the hospital. I was very weak and unable to walk properly, but that’s what I could afford.

When I got to the hospital, they started handling me very delicately -- just like you would handle an egg. I was handed over to Musawo Paul. He counseled me and assured me that I would get cured if I took my medicines as instructed by the health workers.

He would visit me very often, even at times I never expected him to be working. Whatever service I got from Mulago hospital, I can only attribute to Musawo Paul. He really took care of me and checked on me very frequently. He always cared to know how I looked, how I felt, how far I had come, and if I was taking my drugs.

The community linkage facilitators are trained on basic elements of TB control such as directly observed therapy for patients, adherence counseling, TB patient education, home visits, and contact screening, among other roles. They are attached to health facilities that notify and provide treatment to 75 percent of the TB patients in Kampala. Annania continues:

He visited me a minimum of three times a week. Sometimes he would even come at night. I was once prompted to ask him when he stopped working. His response was ‘I am your health worker and you are my patient, so it’s my responsibility to check on you every time.’ Musawo Paul was like a parent to me. Everything I know about TB, I have learned from him. It is impossible to imagine that a total stranger could care for you so much just to save your life.

I expected to spend many months on treatment because I was very sick but I was on treatment for only 6 months. At the end of my treatment I was asked to give a sputum sample, which was tested and I was told that I was cured. I had so many tests done and all came back negative. I was not convinced I was healed as I could not believe it.

TRACK TB works in collaboration with AIDS information Center in Kampala to identify, train and facilitate 46 CLFs to provide TB services at the community level in the different parts in Kampala, including: ensuring direct observation of TB  patients by their relatives while taking TB drugs, tracing of contacts of infectious TB cases at their homes, tracking of treatment interrupters, and TB health education.

Annania successfully completed TB treatment in June 2015 and has since continued to work at his Laundromat.