The Bumpy Road to Uganda's Lyantonde Hospital

We were on the road for quite a while on Tuesday.

Lyantonde is a rural district about three or four hours driving distance southwest from Kampala. Looking out the window, I caught a glimpse of what life for ordinary Africans might be like.

I don't really know what I expected; all of the imagery that I had conjured up about the continent before I came here were basically cliches from movies. I didn't expect people talking in clicks, wielding poison-tipped darts or looking like Libyan terrorists boarding our bus.

The Ugandan countryside is plush and green, it is extremely iconic without being strikingly beautiful. Unlike other parts of Africa, the soil here is fertile, and there are thousands of trees sprouting tropical fruits such as bananas and passion fruit. Along the highway are people gathered in little communities, often sitting in front of small shops.

All the shops are painted vivid colors, like bright purple, that don't mix very well with the surrounding environment and appear this way to advertise for SIM cards companies. If there were a dominant industry here, it would be cell phone credits. It seems like every single person in the city or in the countryside sells airtime. I don't know if this is a good thing or not, but it sure was evident as we passed by thousands of storefronts doused in neon paint.

After about four hours of contemplating this, and of feeling every speed bump and pothole that the road had to offer, I was ready to jump out of the minivan and meet some of the people we had kept passing by. Lyantonde district is where AIDS was first discovered in Africa—initially called "slim disease" because it made people very skinny and frail before they died.

Now, about 30 years later, the region has made a lot of progress toward diagnosing and treating this disease. Central to those efforts in this region is Fred Katumba, MD, the head of Lyantonde District Hospital. This facility is depressingly bare-bones for the the approximately 250 patiens seen there each day. Yet it offers many services such as obstetrics, gynecology, general medicine, basic surgery, pediatrics, infectious disease and specialized HIV/AIDS patient care.The hospital is really a collection of a few old buildings with hundreds of people waiting inside and outside, either to receive care or to visit their loved ones. Inside the hospital there is one small ward for each service and patients lie on cast-iron beds often doubling up with others or in very close distance of one another. Family members who are attending to the patients make a bed on the floor below the patient and are responsible for feeding the patient and buying the necessary supplies and medications. Those without caretakers have a difficult time getting the care they need. Though this is barely a hospital and has almost no infrastructure to speak of.

Yet Dr. Katumba has transformed this into one of the best HIV/AIDS treatment facilities in the country. People come from all over to seek care here, because the program inclues a high degree of follow-up and treatment success rate. Dr. Katumba has recruited community health workers who go to patients' homes and help to ensure their medications are taken regularly. Family members may also assume this role—the idea being that when a patient has a sponsor or partner in their treatment plan, they will be more encouraged to keep with their medication regimen.

Dr. Katumba also has a great patient education program with guidance and counseling to teach patients about their disease and why it is important to remain on ARVs consistently. Another unique program that he has started focuses on commercial sex workers, who frequent Lyantonde because it is a hub of long-distance trucking traffic. He has addressed stigma head-on with this program, by sending healthcare workers into the workplaces of commercial sex workers to test and treat them for HIV and STDs. This program has proven very successful and is actually well-received by the community. Dr. Katumba has made a lot of strides in addressing stigma about HIV/AIDS in his community with the very limited resources that he has to work with.

The countryside is overrun by commercialism, and people are moving out to cities, yet the people I met were friendly and motivated to help change things for the better. It is inspiring to see Dr. Katumba has make postive things happen through being a powerful advocate for his patients—something we can all aspire to!

(For more on the visit to Lyantonde Hospital, see Mona Singh's post on the PHR Student Blog.)

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