Transcript MSEP 2008: Kitgum, Uganda

~ AVSI ~
“Our method is presence.” -- Dr. Pippo Ciantia
“Centrality of the Person
The person is the center of any development program, and
the purpose of every project. This means, first of all, sharing
the needs of the other, who as a unique human being desires
happiness, truth, beauty, justice and freedom. The person
cannot be reduced to a social category or a limitation such as
poverty, disease or disability. Without this recognition of the
human person—being moved by the destiny of the other—the
answer to needs is merely an act of generosity or a political
strategy. The very nature of the person implies relationships—
first and foremost with the family and the community;
consequently, AVSI assumes this context as the starting
point.”
* AVSI website, www.avsi-usa.org
AVSI began at the mission in Kitgum then grew to
Kampala, Hoima, Gulu, and Pader, first by sustaining
healthcare services then by agricultural activities,
which remain the two principle pillars.
“With the war, new challenges came: Sudanese
refugees, displaced Acholi people, child soldiers, the
hygienic conditions in the camps . . . We sustained a
number of orthapoedic laboratories . . . To respond to
the land mines introduced in those times and operated
by the Ugandan guerillas who were arming themselves
in Sudan. The hospital in Gulu thus became the main
rehabilitation center for the wounded and for amputees.
The presence thus responds to the various emergencies
that arise. The answer does not arise from outside, but
is already born there, from daily life.” -- Pippo
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PMTCT training (Meeting Point
and Giovanna)
Agricultural initiatives
Land Mine Awareness
Hepatitis E prevention
(Francesca)
HIV/AIDS education
(Giovanna)
Water and Sanitation (Matteo)
Education/Schools (Anne)
Library for Night Commuters
(Pupa, at Gov’t Hospital)
Rehabilitation of child soldiers
(Lucia)
Orthopoedic surgery (Giorgio
Salandini at SJH)
OB/GYN (Dr. Francesca)
Guinea Worm Eradication
(Pippo)
Recent History of Northern Uganda:
--1971-79 – Idi Amin leads massacre of ~300,000 Acholi.
Amin loses confidence after terrorist incident at Entebbe
airport in 1976.
-- 1979: Obote takes over
-- 1985: Tito Okello (Acholi) leads coup against Obote while
Yoweri Museveni of the NRA in the South organizes guerilla
movement
-- 1986: Museveni (from south) takes over Kampala gov’t.
He is still the president of Uganda.
-- 1986-2003: NRA troops from south terrorize Acholiland,
while Sudanese guerillas (armed by Museveni for political
reasons) make sporadic, unpredictable, and horrific attacks
from the north. (Current rebel leader: Joseph Kony)
2003-today: mostly stable, with little movement of rebels,
but in 2005, 90% of Acholi still lived in IDP camps (Internally
Displaced Persons).
Response
“We have the person in
mind, with all of his
needs, even the most
intimate… This is why
we don’t just want to be
a relief organization; we
don’t just want to give
aid. That isn’t our
nature. . . Northern
Uganda can’t remain
crushed by a neverending emergency. Even
now it’s time to start
setting up
reconstruction.” -- Pippo
# of Meeting Point- Kitgum Clients:
1990: 4 men, 12 women – all died
2007: 74 men, 181 women – 4 men died;
8 women died
Total # clients assisted: 1187 men, 2583 women
“Our method is friendship.”
Ketty, Founder of
Meeting Point
“We open the office and the first thing
we do is to ask God to help us live a
day that will be terrible, we already
know it. Somebody will die, somebody
else will find out he’s sick, somebody
will be orphaned. But we also discover
that all this isn’t a burden. Things are
lighter, more bearable, because of the
friendship between us and the
friendship and love between us and the
sick. There is no distance, no separation.
We’re all taken by the same Love…
Often, without even becoming aware of
it, the healthy are sick in the same way,
even if not with the same virus. They’ve
suffered amputations of their humanity
even if they have hands and feet that
are intact.”
“We see the possibility of living
happiness inside sickness, for however
little or much time you have left.”
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Health Centers Staged as 1-4,
then hospitals
Community awareness (t-shirts,
community events, “National
Guinea Worm Day”, posters,
meetings in camps, etc.)
IDP camps, re-localizations,
agriculture, employment, … etc.
Healthcare is all-encompassing :
work, sanitation, latrines,
nutrition, hand-washing, cultural
issues, polygamy (not accepted in
Acholi culture but practiced
anyway)
Community Health Awareness Day:
Panykel Satellite Camp
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Wards available: Outpatient, Maternity, Medical
Ward, TB Ward, Pediatric, Surgical
Micro lab: really only tests for Malaria and does
Hepatitis blood tests and TB sputum tests (but only
in the mornings, 9am – Acid Fast stain for Bacilli).
Other infectious diseases are a crapshoot.
Not available: anything involving technology
greater than an Ultrasound or Chest X-ray, (ie, no
EKG, cardiology ward, heart cath, MRI, CT, etc.)
Rufina with Mwaba John, a recent
graduate of Gulu University, now
with HIV complications, TB & Malaria
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#1 = Malaria (mostly Plasmodium falciparan, but also p. vivax).
Female anopholes mosquito
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2) Hepatitis (A and E mostly, but also C?)
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3) AIDS complications: TB, pneumonia (pneumocystis carinii)
Current Major Public Health Issues:
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Hepatitis E (Kitgum, Pader, and Gulu. Especially in northeast.
CDC and WHO are working on it along with other NGOs – AVSI
is big here. Also UNHCR, NRC, MSF, etc.)
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Cholera (Congo border)
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Ebola (West Nile region)
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Kaposi Sarcoma (22yo male with AIDS on HAART, cz: HHV8; poor thoracentesis
performed)
Burkett's Lymphoma (12yo girl named Gloria, rapid development of multiple
abdominal tumors. Died in 3 days)
8yo girl with severe Otitis Media with discharge and swollen lymph nodes
8yo girl, acute pyelonephritis in pediatric ward; given urinary catheter; very poorly
monitored. No temp taken, no follow-up from ABs, IV drip was gone when I
checked on her. (transferred to Gulu via Salandini)
Infectious diseases, probable: Salmonella typhi, Schistosomes (liver flukes),
Cryptococcus (CNS entry)
Sickle cell anemia (facial malformations – look up?)
12yo girl with heart failure (dyspnea, edema). No available surgical correction, given
digoxin
Peds ward: Ritual cutting on chest - infected, Mandibular abscess (infected
toothache), Ringworm (tinea capita, on head),
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Malaria: I.V. Quinine, Coartem, with
supportive treatment: dextrose sol'n
Hepatitis E: support only, no treatment.
Especially deadly for pregnant women
HIV: ARTs (a variety of combinations
available)
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A major project of
AVSI and Meeting
Point
Venues: St. Joseph’s
Hospital and every
village in the
northern region
HIV testing,
counselors, nurses
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Week 1: Shadow at Meeting Point – observe PMCT training at SJH, travel to
villages for follow-up visits, try to understand office management of adult
HIV clients and OVC (orphans and vulnerable children) program
Week 2: Shadow Ugandan doctors and medical students in the Medical
Ward at SJH; also pre-natal exams with Nurse Betty
Week 3: Attend training for “Faithful House” marriage seminar, promoting
faithful marriages and strong families. Founded by Ugandan married
couple (Gonzaga and Paskazia) Fantastic!
Week 4: Attend training for “Value of Life” seminar for secondary school
students to be encouraged to recognize their own great dignity and to ask
the most important questions about their life. The program is to promote
abstinence until marriage and to continue to build up a culture torn by war.
Also began data entry of ART clients on Excel for Meeting Point and visited
clients
Week 5: Continue work at Meeting Point, home visits, school visits, and
hospital visits for OVC and adult clients. Visit orphanage for handicapped,
deaf, and former child soldiers.
Week 6: Back to AVSI-Kampala for a few days of meetings/work/seeing
Kampala before leaving for US via AMS
AVSI hostel =
 L'Italiani, volleyball,
pasta, movies,
 Land Cruisers.
 Very bad roads –
difficult to move
between villages
 Locals living with fear of
rebels and abduction
(Joseph Kony, Sudanese
border)
 Youth still missing (ie,
Gerald's brother)
 Matteo… Karamajo
(gunshots during Mr.H.O,
explain)
(where real culture still exists…)
Bwola dance
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War Dance -- a documentary movie on the conflict in
Northern Uganda
Check out AVSI website: http://www.avsi-usa.org
Books: Irene's Eyes
Kop Ango?
Movie: “Great Things” documentary on Meeting Point
– Kampala
Movie: The Last King of Scotland (?maybe… gruesome,
though. About the terror of Idi Amin)
American NGO begun by ND grad/friend: Resolve
Uganda http://www.resolveuganda.org/