The Lake Victoria Basin Integrated Health Initiative (LVBIHI)

Field Visit #1: The Ssese islands

            First, I would like to introduce the team members that I have the privilege of working with on this fantastic initiative. Dr. Michael Marks, an obstetrician trained in UK who has dedicated the past 20 years of his life working to improve maternal health and well-being throughout Sub-Saharan Africa. Dr. Marks is the founder of the Bush Hospital Foundation, an NGO that advocates for and support primary health care in selected African countries. The bulk of their efforts are directed towards the supply of medical equipment and essential medicines to hospitals and clinics in remote areas. Dr. Mike is currently a medical advisor for another NGO, Direct Relief International and is the spear header of the LVBIHI. 

Dr. Mike with a Village Leader on Kitobo Island

                The second team member that I am working with on this initiative is Hilary Bowman, a supply chain logistician from GlaxoSmithKline (GSK) Inc. who is currently volunteering with AMREF under the compassionate branch of this large scale pharmaceutical firm. Now I can imagine what some readers are thinking-how can one suggest compassion and humanitarianism in the same sentence as the words large scale and pharmaceutical firm…? Guilty I am of the same question! If you’re interesting, I suggest you check out this pdf file and this youtube video to learn more about Andrew Whitty, the foreward-thinking CEO of GSK, as he professes his commitment to social responsibility by directing 20% of profits to strengthening health systems in developing countries.

Hilary outside of Rwendero Health Centre III
holding the nurse's 4-month old baby boy, Soloman

                To summarize the LVBIHI, it is a concept to deliver quality, affordable health care to reduce the high burden of disease in the Lake Victoria Basin. The Lake Victoria Basin includes all of the islands and districts surrounding Lake Victoria in Uganda, Kenya and Tanzania. This project is a partnership consortium between AMREF, Direct Relief International (DRI) and Marie Stopes International (MSI). The project aims to address the needs and gaps within current health systems which currently impede the delivery of quality healthcare to more than 30 million East Africans. By working with relevant Ministries, NGO’s and community based organizations, this project aspires to strengthen health care and promotional interventions focused particularly on sexual and reproductive health and rights, maternal, neonatal and child health, malaria, HIV/AIDS, TB, preventable communicable diseases and other water, sanitation and hygiene-related conditions (Millennium Developments Goals 4, 5, 6 and 7).

                I joined the team in the middle of their journey and just in time to travel to the Ssese islands, an archipelago consisting of 84 islands of which only 18 islands have a population greater than 2,000 inhabitants. The Ssese Islands represent one of the largest districts in Uganda covering 8,634 square kilometers, however less than 5% is land, the rest water. The total estimated population of all islands combined is approximately 54,000 and due to low population density, this district receives one of the smallest allocations in terms of health budgets. As such, the islands carry one of the highest burdens of disease. Health care is often difficult to access as is in many rural areas around the world. A mesmerizing three-quarters of current health issues are preventable at the household level, however, due to access to prevention interventions and an inability to access care in a timely manner morbidity and mortality are high. Care is severely impeded by wide-spread poverty and infrastructure issues such as access to affordable transport and a lack of provision to services by qualified health professionals.

From the mainland

                In total, we visited 6/11 of the health centers ranging from level II to level IV and 3/46 level I Village Health Teams. I was unfamiliar with this grading system are first, so a brief description of each: Level I refers to the village level in which village-elected representatives provide health education and are capable of treating conditions such as malaria and diarrheal disease; Level II refers to the parish level, this is the first point of contact with qualified health professionals such as a nurse and/or midwife; Level III refers to the sub-district centre which provides outpatient, inpatient, maternal services and HARRT (highly active anti-retroviral therapy); and Level IV refers to district level facilities, this is the point of contact with a qualified medical doctor and where surgeries take place. We also met with District Health Officers and several community leaders throughout the week.

Meeting with a Village Health Team under a wise old tree

                 Our interactions within these communities were simple, we would ask, “what do you think you need to improve health within your community”. Over and over again we heard the same response: Clean drinking water; improved maternal health services; retention of medical workers; transport whether it be by boat or land to ensure better access to tertiary care services; full-time supplies to medicines for treating malaria, bilharzias and HIV; full-stock of childhood immunizations; life jackets for fisherman; bed nets for all household members (current government allocations only ensure enough nets for children under five years and pregnant woman). They never asked for too much- just access to very basic human rights which they have been denied for far too long.

Kasekulo, a village of approximately 3,000

                At night after our field visits, Dr. Mike, Hilary and I had long drawn conversations and reflected on the happenings of the day. We would recount the interactions of the day and were constantly generating new questions. One of the questions we asked to a nurse in a health centre II was, “Why do you think the prevalence on HIV is so much higher here on the island (30%) than it is on the mainland (6%)”. Her response, “People here like sex too much”. Hmmmm…. We probed a little farther and were struck with another reality. On the island several of the inhabitants are transient. During fishing season high time many men come and go and bring with them the attitude “My job’s risky, I may die tomorrow, mine as well live it up today.” This promotes the intake of homemade alcohols, an influx of sex workers and fishermen with cash on hand daily. With no government structure to promote savings or any reason to believe the money can be better spent, there is a very laissez faire attitude toward personal responsibility. So who to blame? The fishermen? The government who demand high levels of exports? The importers who demand low prices for Nile perch?

Fishing village of Mazinga

                Aside from transient fishermen, there is a new industry on the island bringing transient palm plantation workers, thus exacerbating the above scenario. At first glance, it appears as though these plantations are a great initiative and an opportunity for income generation for locals, but one has to consider, at what cost? Hundreds of acres of rain forest have been flattened to make way for palm, a slow growing tree with a small yield per hector. Since the establishment of the plantations, the temperatures on the land have increased and draught has paralleled. When rain does come, there are less tree root systems to manage floods, causing pools of stagnant water- just perfect for breeding mosquitoes that often carry the malaria parasite. There is a loss of diversity in both flora and fauna on land in the surrounding water leading to less minnows, less fish, and less work for fisherman, leading to longer hours on the water, riskier nights works, reinforcing the attitudes mentioned above. Palm plantations. Good idea or bad idea for the people of the islands? To me, this is an excellent example of how short term solutions (palm plantations to increase income generation for locals within a short time frame) can have negative long term implications. Improving quality for the people on this island cannot come vertically from the outside; solutions have to be generated by the people, for the people and with the support of nations who can afford to share their wealth. We need holistic approaches.

Charles holding raw palm fruit ready to be boiled, juiced, reduced
and sold as cooking oil or further produced into body lotion

Acres upon acres of palm

                I’ll end this post here for today. I think this is enough food for thought for one afternoon- I could go on, but I’d never sleep! Share your thoughts, I’m interested to hear.