The past few of days have involved more outreach observations. On Thursday, I traveled with a counselor, Teddy, to follow up on several Omoana House children that have been reintegrated. We went to two main areas: Kakira and East Jinja.
The first place we stopped at was Kakira. One of the major features that dominates the town is the Kakira Sugar Factory and Plantation. It is a massive operation covering many acres. It is a family owned business dating back to the 1920s. From what I understand, the family is English. The operation is almost totally self-contained where the factory has it’s own hospital for workers, several schools for worker’s children, shops and markets. It is a throwback to the old autonomous corporations where workers had all their needs met by the company. Kakira itself is a very beautiful area with green rolling hills among the sugar cane fields and it is several miles east of Jinja, just off the Trans-African Highway. The case we were looking into was for a 6-year old girl named Winnie. The purpose of the trip was to meet the father and see how he was doing and then travel to the school to pay school fees. You see, the Omoana House’s mandate is such that once a child is entered into the program, it becomes the responsibility to nurse, rehabilitate, reintegrate, and finally monitor the progress of the child outside of Omoana. This can be till the child reaches University or some other factor – such as vocational school or employment. The background for the case was that the father was an alcoholic and did not properly support the child who eventually became malnourished and was referred to the Joint Clinical Research Center (JCRC) hospital in Kakira due to the fact the child was HIV+. (Side note: JCRC and another organization called The AIDS Support Organization (TASO) are the two major non-governmental organizations in Uganda that provide HIV medication and support). JCRC then referred the child to Omoana House where they nourished the child for nine months before returning the child to the father. I also learned that the mother had died on Feb 13th. I was not sure if it was because of AIDS and Teddy did not know why either. When we arrived at the father’s house, he was still sleepy since he had informed us that he worked at the factory at night (I am thinking the factory runs 24/7). At the house, he was also staying with a cousin who was also helping out with the children (I learned that he also had two older children a well). We asked him to show us the school and we drove to the Karongo Nursery School. There we met the head mistress where Teddy paid for the school uniform and fees for the year. The head mistress had a few questions to ask about Omoana and St. Francis. The head mistress then began to counsel the father! She said, “You must love your child and support her. If you do that, then there will be no problems.” They brought Winnie to us and I found that she looked to be maybe 4 yrs old instead of 6, in my opinion. She was a very bright and cheerful girl and readily came up to introduce herself to me and to the others. We left the school and then dropped off the father. We made a couple of other trips to pay for school fees and visit the children. One situation caught my attention in that we visited a little girl and her father. The mother had run off and the father was in charge (apparently this happens quite a bit where it is the responsibility of the father to support the children – if the wife leaves or separates then normally the father is stuck with the children which leads to then the father’s mother coming into the picture to help raise the child and, hence, the grannie program). In addition, as a side note, the father was an albino which is something to see in Africa. He had pale skin and freckles and had almost blue eyes. His daughter looked like any other African child.
On Friday, I went along on another Home-based care trip with some of the Omoana staff now working on a St. Francis Outreach trip (remember that the Omoana staff is hired through St. Francis). We went to a fishing town that is on Lake Victoria. It is a far trip and took us over an hour and a half to reach the village. The roads as you got closer to the village got steadily worse as you went. Finally it was nothing more that semi-flattened loose dirt and rocks. If a moderate rain was to fall, the roads would hardly be passible. The village is called Nkombwe and is on the tip of a peninsula. The view of the lake is spectacular. One thing I noticed right away was the lack of boat traffic. For such a big lake, there was very little to see in terms of human activity on the water. It was as if they just stopped on the lake shore and it became an impenetrable obstacle save for the occasional fishing canoe. There we met the local CCA (I mentioned this program before in an earlier blog post). Again, the value was evident where the CCA had arranged a site to set up the counseling and drug distribution area. She had also coordinated bringing in the clients to the area as well. She herself is HIV+ and received free services from St. Francis. The other clients dutifully paid the 2,000 UGx user fee. One client that was pointed out to me: Mathias Serushago, 58 yrs old. When he first started ART about a year ago, his CD4 count was 153. Now it is up to 468 at his last test. I was informed that this is a huge turn around for a patient. One patient did not show up so it was decided to leave her prescription with the CCA to await her arrival. Again, this is something that makes this program successful in my opinion. One other thing I noticed on the client list was that about half the patients were on ARVs even though they had HIV. The counselor explained to me that the there is a charge for the CD4 test to be conducted (10,000 UGx) which some do not want to pay. Also, some do not want to have to be on ARVs, so they are issued Septrin (which St. Francis is now out of) instead to help prevent infections.
On Saturday, I went with the Granny program staff, including a nurse, to visit a grandmother and also a grandmother group.
The first place we went to was a home in Mbiko which is very close to St. Francis. The grandmother who lived there was by herself mostly and was caring for six grandchildren. There was a younger woman there as well whom we did not know who she was at first. The grandmother coordinator interviewed the grandmother and learned that she had recently gone to another clinic closer to Jinja. There she was diagnosed with port-malaria syndrome and given several types of medication which she had failed to take! In addition, the medication cost 15,000 UGx (it would have been free at St. Francis). The grandmother coordinator encouraged her to take her medication while we were there. Also, the staff conversed with the the younger woman and learned that she was the eldest daughter of the grandmother. She was also the retired nurse. When asked why she did not follow up with the medication for her mother, she claimed that she was too busy helping with a local political campaign! She also felt that she knew how to take care of her mother. Rather than grill her further and cause some difficulty, we left after observing the grandmother take her medication. The staff also encouraged her to go to St. Francis in the future since treatment would be much cheaper.
The second stop was to visit a local grandmother group to see if they needed any follow up care. When we arrived at the scene, no one was there. The grandmother coordinator called the group and learned that they had waited for them but left after a while. In addition, no one was sick or needed attention. This raised some interesting points for me with regard to home-based trip preparation and ensuring that there is a need to make the trip since fuel costs are high here in Uganda. Also, there were several delays before we left St. Francis which contributed to our late departure.