Panyadoli Health Center Clinic. Bweyale, Uganda. I. Demographic Information 1. City & Province. Bweyale, Uganda

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Panyadoli Health Center Clinic Bweyale, Uganda Date: Prepared by: 20th, February 2014 Naku Charles Lwanga and Jonathan White I. Demographic Information 1. City & Province Bweyale, Uganda 2.

1 Panyadoli Health Center Clinic Bweyale, Uganda Date: Prepared by: 20th, February 2014 Naku Charles Lwanga and Jonathan White I. Demographic Information 1. City & Province Bweyale, Uganda 2. Organization: Real Medicine Foundation Uganda ( World Children s Fund ( 3. Project Title: Panyadoli Health Center Upgrade and Support 4. Reporting Period: Oct 1 st, 2013 Dec 31 st, Project Location (region & city/town/village): Panyadoli Health Care Center, Bweyale, Uganda 6. Target Population: About 60,000 residents in the Bweyale region, including 41,000 Ugandan IDPs, Bududa survivors, and Refugees from Kenya, Sudan, Congo, Burundi and Rwanda which are the main target population; we saw an influx of 10,000 new Ugandan IDPs in October 2010 and another 15,000 joined the Kiryandongo Resettlement Camp at the end of May II. Project Information 7. Project Goals: Upgrade to and maintain the clinic at a new hygienic and operating standard; to restore optimal function back to the levels prior to IRC pull out and reduction in UNHCR support. 8. Project Objectives: Provide medicine, medical supplies, and medical support Support the Health Management Information System Maintenance (staff and petrol supply) Maintain hygiene at clinic to Best Practice Western Medicine standards Enhance existing structures for Malnutrition Ward and Main Center Provide cooking materials such as charcoal stoves, saucepans, utensils, etc. Upkeep and renovation of the health center through periodic re-painting and re-plastering 9. Summary of RMF/WCF-sponsored activities carried out during the reporting period under each project objective (note any changes from original plans): RMF provided the Panyadoli Health Center with medicines and medical supplies, and covered all existing gaps during this reporting period. Three ward cleaners and two ground keepers sponsored by RMF groomed the grounds regularly and made sure the cleanliness of the wards and offices was well maintained. Continued maintenance of water pipes and solar pump installation. 10. Results and/or accomplishments achieved during this reporting period:

2 The coordination of regular medicine supply to the health center continues to make a significant difference to the community and maintains the center s treatment capacity and overall reliability. The wards are kept clean, and equipped with medicines and supplies; a joint effort of RMF, the Kiryandongo local government, and the UNHCR. The grounds are continuously cleaned and maintained, making it safe to walk around without fear of being bitten by snakes. The Solar Powered Water Pump is continuing to run successfully, providing clean running water to the clinic wards and offices, and greatly increasing hygienic conditions of the clinic. 11. Impact this project has on the community (who is benefiting and how): Through RMF/WCF s support, the Panyadoli Health Centre has become a reliable source of health care within the community. Prior to RMF/WCF providing this support, patients could not be treated properly due to a lack of sufficient medicines and supplies. Patients continue to come from many different parts of Kiryandongo with some patients even leaving Kiryandongo Main Hospital to come to the Panyadoli Health Centre because of better availability of medications and supplies. Also, many patients cannot afford to be treated at local private clinics in Bweyale. RMF s support has increased the attention of local Kiryandongo government and UNHCR for the health center. UNHCR has fenced the whole health center while RMF completed the painting of it. The government has now expressed interest in possibly upgrading Panyadoli Health Centre from a Health Centre III to a Health Centre IV. 12. Number served/number of direct project beneficiaries (for example, average number treated per day or month and if possible, per health condition). 5,913 patients were treated during the 4 th Quarter of During the month of October: 1,996 patients were treated at the health center, of which 765 were male and 1,231 were female. During the month of November: 2,259 patients were treated at the health center, of which 804 were male and 1,455 were female. During the month of December: 1,658 patients were treated at the health center, of which 715 were male and 943 were female. 2 deaths were reported at the clinic during this Quarter, one due to acute malnutrition and one due to too much alcohol in the body at old age. 13. Number of indirect project beneficiaries (geographic coverage): Over 60,000 in the refugee settlement and surrounding community combined. 14. If applicable, please list the medical services provided: Please review Please list the most common health problems treated through this project. Malaria Cough Intestinal Worms Skin Disorders 16. Notable project challenges and obstacles: South Sudan Refugee Crisis in Uganda/Kiryandongo Fighting between government troops and rebels in South Sudan has so far killed thousands of people and displaced more than 1,000,000 since it began in mid-december Many people have been forced to

3 take shelter in refugee camps along the borders and in Uganda. RMF has supported the Kiryandongo Refugee Settlement since 2008 with a refugee population from several East African countries, and is now seeing a large influx of new refugees from both South Sudan and the DRC. A month of conflict has displaced about 413,000 people in South Sudan, the United Nations said Wednesday, after a major surge in the number of people fleeing violence in the past week. The violence has also forced about 78,000 to flee to neighboring countries, the United Nations said, on top of the hundreds of thousands displaced within South Sudan's borders. Many are women and children. More than 42,000 people are now in Uganda's West Nile region, according to the United Nations' refugee agency, the UNHCR, while about 18,600 have sought refuge in Ethiopia. RMF has been informed by the Kiryandongo Settlement administration/office of the Prime Minister that in addition to the more than 12,000 South Sudanese refugees that have already arrived, to expect as many as 40,000 new refugees from West Nile to be transferred to Kiryandongo, greatly increasing the current needs of the camp. The Congolese Refugee Crisis in Uganda Recent fighting has driven an influx of more than 65,000 refugees from DRC into Uganda. The situation continues to be dire. There is no water, sanitation, healthcare, shelter, or roads to support these people and all repatriation processes have been halted. The establishment of additional shelters, water sources, communal kitchens, start-up vaccination for under-five-year-olds and support to existing health centers have been ranked as urgent priorities. The refugees are currently camping at the Bundibugyo and Kyangwali Refugee Settlement areas at Bubandi sub-county headquarter land. RMF has provided a large supply of medicines and supplies to Bundibugyo, and we have been asked again by the medical leadership at the camp to continue supplying urgent medicine needed that is currently not being provided by other INGOs. The situation continues to be desperate, especially for small children and pregnant women. In addition a large number of these refugees are likely to be relocated to the Kiryandongo Refugee Settlement, and specifically need the support we provide in the Panyadoli Health Center. Because the outlying community of 55,000 also depends on the clinic for health care, medicine inventories are often depleted quickly as the demand exceeds the government s, UNHCR s and RMF/WCF s budgets for medicines for the refugee settlement. The staff quarters continue to be compromised and there is no budget for performance incentives. 18 families, who live on site, share only 2 latrines and a falling kitchen structure to prepare meals. Enlisting their support for additional programs at times is difficult. The unstable dollar exchange rate has also caused drug prices to continue to increase. 17. If applicable, plans for next reporting period: Continue to purchase medicines and medical supplies as needed. RMF and the Panyadoli team are continuing to look into the possibility of upgrading the health center into a hospital if additional funding is found. In addition to more possibilities for patient care, this would also attract additional government funding. 18. If applicable, summary of RMF/WCF-sponsored medical supply distribution and use: RMF provides medicines, medical supplies, emergency medicines and medical support. Please see Appendix A 19. Success story(s) highlighting project impact: See Appendix B 20. Photos of project activities (file attachment is fine):

4 Please see Appendices A and B III. Financial Information 21. Detailed summary of expenditures within each budget category as presented in your funded proposal (file attachment is fine). Please note any changes from plans. Sent separately. APPENDIX A Drug and medical supplies delivered to the Panyadoli Health Center by RMF/WCF this quarter:

APPENDIX B Success Stories Wagutwa Elinesty Wagutwa Elinesty, is 44 years old and lives outside of the settlement in a nearby town, came to the clinic with chest pain, a bloody cough and general body

7 APPENDIX B Success Stories Wagutwa Elinesty Wagutwa Elinesty, is 44 years old and lives outside of the settlement in a nearby town, came to the clinic with chest pain, a bloody cough and general body weakness and was diagnosed with severe respiratory tract infection. He was treated successfully with IV ampicillin 1g every 6 hours for five days, im Diclofnac 75mg every 8 hours for 3 doses, tablet ibuprofen ii for 3 doses.

He narrates: I am very happy to be near this Kiryandongo settlement for one reason that the health standard of the population around has improved through Panyadoli health centre and this has

8 He narrates: I am very happy to be near this Kiryandongo settlement for one reason that the health standard of the population around has improved through Panyadoli health centre and this has supported our community through the outreaches the health centre staffs do carryout weekly. Because of these outreaches, communities have improved their sanitation levels and that is why you can see me the only one admitted on the male ward. However this does not mean that my household sanitation is poor, sickness has no time table for anybody. I just thank the implementers and donors who have made this facility to be without inequality, whether you are a national or a refugee, the same services are given and may these services continue for the benefit of the nation Elinesty spent three days in Panyadoli health centre before he was discharged and his condition improved as confirmed by the recent outreach to his home by our support staff. In Uganda, especially this season (months of December to March) the temperature are very hot during daytime and very cold in the morning hours, with high winds bringing unhealthy dust to the community. There have been many patients diagnosed with respiratory tract infections recently and we are hoping that bacterial conjunctivitis does not emerge. Apio Jane: Apio Jane, is 49 years old and a resident of the Siriba village in Bweyale town council came to the clinic with Epigastric pain and was diagnosed with severe pelvic inflammatory disease (PID). Her treatment was with IV ceftresone 1gm od for 5 days, capsules of Omeprazole 20g od for 10 days, tablets of magnesium ii tds for 3 doses, Albendazole 400g od for 3 doses, vitamin B complex ii for 3 doses and paracetamol 1g as a pain killer. Jane says: This health centre is in the settlement where many would say it is only meant for the refugees but all nationalities access the services. The reason as to why I left all the health facilities in Bweyale is because of the quality services offered at Panyadoli health centre are higher, and the availability of the medication better, I thank all the organizations that have put their hands together to help/save mankind in this health centre.

Kamami: Kamami, is 75 years old and a resident of Kiryandongo in settlement 18, 22 kilometers away from Panyadoli health centre came to the clinic with a serious cough and was diagnosed with a severe

9 Kamami: Kamami, is 75 years old and a resident of Kiryandongo in settlement 18, 22 kilometers away from Panyadoli health centre came to the clinic with a serious cough and was diagnosed with a severe respiratory tract infection. Her treatment was on IV Ampicilin 500mg every 6 hours for 5 doses, Gentamycine 80mg OD for 5 doses, tablets Panadol for 3 doses. She narrates: Since I came to Kiryandongo settlement in 2008, I have always been treated from Panyadoli health centre with services and help with drugs, clothing,shoes, and more. I never imagined being in a foreign country then you find a parents like RMF who have cuddled me from the start of a refugee life, indeed God makes a way where seems not to be way am now comfortable living in Uganda because I/my sons would have to spend a lot of money on frequent treatment as you can see me aged,in Kenya. I ALWAYS SAY, GOD BLESS THE HANDS THAT GIVE (RMF).

Her treatment was: IV quinine 300mg in 5% dextrose 300mls, every 8 hours for 3 doses, oral tablet Coatem, and Panadol.

10 Abalo Jane Abalo Jane, 12 years old, a resident of cluster M in refugee settlement areas came to the clinic reporting nausea and fever. After carrying out laboratory test, she was confirmed to have severe malaria. Her treatment was: IV quinine 300mg in 5% dextrose 300mls, every 8 hours for 3 doses, oral tablet Coatem, and Panadol. Abalo narrated: I thank UNHCR and RMF for availing us the refugees with health services at our best freely, besides, my parents are poor, cannot afford expensive and distant health units.

Atoo Esther Atoo Esther, is 35 years old and a resident of cluster K, who came to the clinic with a serious cough and was diagnosed with a severe respiratory tract infection.

11 Atoo Esther Atoo Esther, is 35 years old and a resident of cluster K, who came to the clinic with a serious cough and was diagnosed with a severe respiratory tract infection. Her treatment was: IV Ampicilin 500g every 6 hours, for 3 doses, iv CAF 250mg every 6 hours for 5 doses, Tablet salbutamol 4mg every 8 hour for 5 doses. Esther who was being taken care of by her mother narrated: Without RMF my whole family life would be in danger since I do not have any business that can support my husband s salary and at this time of sickness where could I get money to buy these expensive drugs, I thank RMF for its great support in this health facility and my family too and may God bless those who implement RMF program in Kiryandongo refugee settlement. Esther is among the people who have seen and witnessed the direct services of RMF pictured above with a blanket she received from RMF, donated to the health centre to be used by patients who come with no bed sheets and blankets. Ajok Monica Ajok Monica, is 28 years old and a resident of the California Zone outside of Buwate town, visited the clinic and was confirmed to have severe malaria after laboratory testing as well as signs and symptoms of a severe respiratory tract infection. Her treatment was: IV ceftrasone 1gm OD for 5 doses, Tablets coatem 4 bd for 3 doses, Panadol 1g tds for 3 doses. In spite being of being closer to the district hospital, Monica made her mind to trek on foot 9 kilometers to Panyadoli health centre III. She narrates: Whenever I am admitted in this facility, I have hope of getting better faster not only due to availability of drugs but also due to communication linkages since I do interact with the clinical officers and nurses freely and they are able to understand my sickness very well unlike district hospital where

communication gap is too much and workers tend to speak almost 90% local language of their origin and this hinder free communication from the patient s heart.

12 communication gap is too much and workers tend to speak almost 90% local language of their origin and this hinder free communication from the patient s heart. In Panyadoli health centre, we have three major languages, which are English as official language of the country, followed by Kiswahili as is believed to be spoken almost by 80%, and Luo since the majority in the settlement and the IDPs around and even the host communities speak Luo. Above all we have support staff that at times translate/interpret so as to bring a patient and health workers better communication regarding the symptoms and diagnoses..

13 APPENDIX C MORBIDITY REPORT Health Unit: Panyadoli Health Centre 111 Month: October OPD ATTENDANCE AND LABORATORY TESTS TOTALS FOR THE MONTH LABORATORY TESTS Category Number of tests No. positive done Male Female Male Female Malaria blood smear TB sputum Syphilis screening Pap smear Other lab tests OUT PATIENT ATTENDANCE Category 5 years and 0-4 years above Male Female Male Female New attendance Re attendance Total attendance Referral to unit (all ages) Referrals from units (all ages) OUT PATIENT DIAGNOSES 5 years and 5 years and 0-4 years 0-4 years Diagnosis above Diagnosis above Male Female Male Female Male Female Male Female 34 Death in Epidemic Prone Diseases OPD 01 Acute Flaccid Paralysis Maternal and Perinatal Diseases

14 02 Cholera 35 Abortions Dysentery Malaria in Pregnancy Guinea Worm 37 High blood pressure in pregnancy Obstructed Meningitis(meningococcal) Labor 39 Hemorrhage Related to 06 Measles pregnancy (APH &/ or PPH) 40 Perinatal 07 N Tetanus (o-28 days Conditions(in age) newborns (0-28days) 08 Plague Non Communicable Diseases 09 Rabies 41 Anemia 10Yellow Fever 42 Asthma All 11 other viral Hemorrhagic Diastases and Fevers conditions 12 other emerging 44 Diabetes infectious disease(specify) Mellitus Gastro - Intestinal Other infectious/ communicable Diseases disorders(noninfective) AIDS Hypertension Acute Diarrhea Anxiety Disorders 15 Persistent Diarrhea 48 Mania 16ENT Conditions Depression 17 Eye conditions Schizophrenia 18 Sexually transmitted 51 Alcohol & infections(sti) Drug abuse 19 Urinary Tract Childhood

15 Infections(UTI) Mental Disorders 20 intestinal worms More Non-Communicable Diseases 21 Leprosy 53 Epilepsy Malaria Other forms of mental Illnesses other 23 Other types of Cardiovascular meningitis Diseases 56 Severe 24 No Pneumonia- Cough Malnutrition or cold (Kwashiorkor & Marasmus) Pneumonia Low weight for Age Schocericiasis 58 Injuries- Road Traffic Accidents 27 Onchocerciasis 59 Injuries (trauma due to other causes0 28 Skin Diseases Animal/ Snakes Bites other Diagnosis 29 Tuberculosis New (Priority Cases) Diseases for District) 30 Typhoid Fever All Others Tetanus (over 28 days age) 32 Sleeping Sickness Total Diagnoses Pelvic Inflammatory Disease (PID) MORBIDITY SUMMARY-NUMBER OF PATIENTS TREATED AGE MALE FEMALE SUB-TOTAL 0-4 YEARS

16 5 YEARS AND ABOVE TOTAL MORTALITY REPORT S.NO. SECTION NUMBER OF DEATHS CAUSE OF DEATH 1. Medical Maternity Pediatric Therapeutic feeding center Surgical TOTAL THE MOST PREVALENT DISEASES IN OCTOBER 2013 S. NUMBER NAME OF DISEASES NUMBER OF PATIENTS TREARED 1. Malaria Cough Intestinal worms Skin diseases 62 MORBIDITY REPORT Health Unit: Panyadoli Health Centre 111 Month: November OPD ATTENDANCE AND LABORATORY TESTS TOTALS FOR THE MONTH LABORATORY TESTS Category Number of tests No. positive done Male Female Male Female Malaria blood smear TB sputum Syphilis screening Pap smear Other lab tests OUT PATIENT ATTENDANCE

17 Category 5 years and 0-4 years above Male Female Male Female New attendance Re attendance Total attendance Referral to unit (all ages) Referrals from units (all ages) OUT PATIENT DIAGNOSES Diagnosis 5 years and 5 years and 0-4 years 0-4 years above above Diagnosis Femal Mal Femal Mal Femal Mal Femal Male e e e e e e e Epidemic Prone Diseases 34 Death in OPD Acute Flaccid Paralysis Maternal and Perinatal Diseases 02 Cholera 35 Abortions Dysentery Malaria in Pregnancy Guinea Worm 37 High blood pressure in pregnancy Obstructed Meningitis(meningococcal) Labor 39 Hemorrhage Related to 06 Measles pregnancy (APH &/ or PPH) 40 Prenatal 07 N Tetanus (o-28 days Conditions(in age) newborn (0-28days) 08 Plague Non Communicable Diseases 09 Rabies 41 Anemia Yellow Fever 42 Asthma

18 43 All 11 other viral Hemorrhagic Diastases and Fevers conditions 12 other emerging 44 Diabetes infectious disease(specify) Mellitus Gastro - Intestinal Other infectious/ communicable Diseases disorders(noninfective) AIDS Hypertension 14 Acute Diarrhea Anxiety Disorders 15 Persistent Diarrhea 48 Mania 16ENT Conditions Depression Eye conditions Schizophrenia 18 Sexually transmitted 51 Alcohol & infections(sti) Drug abuse 52 Childhood 19 Urinary Tract Mental Infections(UTI) Disorders 20 intestinal worms More Non-Communicable Diseases 21 Leprosy 53 Epilepsy Other 22 Malaria 13 forms of mental Illnesses 55 other 23 Other types of Cardiovascula meningitis r Diseases Severe 24 No Pneumonia- Cough 14 Malnutrition or cold 7 (Kwashiorkor & Marasmus) Low weight 25 Pneumonia for Age Schocericiasis 58 Injuries- Road Traffic Accidents 27 Onchocerciasis 59 Injuries

19 (trauma due to other causes0 28 Skin Diseases Animal/ Snakes Bites other Diagnosis 29 Tuberculosis New (Priority Cases) Diseases for District) 30 Typhoid Fever All Others Tetanus (over 28 days age) 32 Sleeping Sickness Total Diagnoses Pelvic Inflammatory Disease (PID) MORBIDITY SUMMARY-NUMBER OF PATIENTS TREATED AGE MALE FEMALE SUB-TOTAL 0-4 YEARS YEARS AND ABOVE TOTAL MORTALITY REPORT S.NO. SECTION NUMBER OF DEATHS CAUSE OF DEATH 1. Medical 01 Failure response to treatment due to high consumption of marijuana and alcohol in an old age with no one taking care of him. 2. Maternity Pediatric 01 Severe Acute Malnutrition 4. Therapeutic feeding center Surgical TOTAL THE MOST PREVALENT DISEASES IN NOVEMBER 2013 S. NUMBER NAME OF DISEASES NUMBER OF PATIENTS TREATED

20 1. Cough Malaria Intestinal worms Diarrhea Acute Urinary Tract Infection 45 MORBIDITY REPORT Health Unit: Panyadoli Health Centre 111 Month: DEC OPD ATTENDANCE AND LABORATORY TESTS TOTALS FOR THE MONTH LABORATORY TESTS Category Number of tests No. positive done Male Female Male Female Malaria blood smear TB sputum Syphilis screening Pap smear Other lab tests OUT PATIENT ATTENDANCE Category 5 years and 0-4 years above Male Female Male Female New attendance Re attendance Total attendance Referral to unit (all ages) Referrals from units (all ages) OUT PATIENT DIAGNOSES Diagnosis 0-4 years 5 years and Diagnosis 0-4 years 5 years and

21 above above Male Femal Mal Femal Mal Femal Mal Femal e e e e e e e Epidemic Prone Diseases 34 Death in OPD 01 Acute Flaccid Paralysis Maternal and Perinatal Diseases 02 Cholera 35 Abortions Dysentery Malaria in Pregnancy Guinea Worm 37 High blood pressure in pregnancy Obstructed Meningitis(meningococcal) Labor 39 Hemorrhage 06 Measles Related to pregnancy (APH &/ or PPH) 40 Prenatal 07 N Tetanus (o-28 days Conditions(in age) newborn (0-28days) Plague Non Communicable Diseases 09 Rabies 41 Anemia Yellow Fever 42 Asthma All 11 other viral Hemorrhagic Diastases and Fevers conditions 12 other emerging 44 Diabetes infectious disease(specify) Mellitus Gastro - Other infectious/ communicable Diseases Intestinal disorders(noninfective) AIDS Hypertension Anxiety 14 Acute Diarrhea Disorders

22 15 Persistent Diarrhea 48 Mania 16ENT Conditions Depression Eye conditions Schizophrenia 18 Sexually transmitted 51 Alcohol & infections(sti) Drug abuse Childhood 19 Urinary Tract Mental Infections(UTI) Disorders 20 intestinal worms More Non-Communicable Diseases 21 Leprosy 53 Epilepsy Other 22 Malaria 10 forms of mental Illnesses 55 other 23 Other types of Cardiovascula meningitis r Diseases 56 Severe 24 No Pneumonia- Cough Malnutrition or cold (Kwashiorkor & Marasmus) Low weight 25 Pneumonia for Age Schocericiasis 58 Injuries- Road Traffic Accidents 27 Onchocerciasis 59 Injuries (trauma due to other causes0 28 Skin Diseases Animal/ Snakes Bites other Diagnosis 29 Tuberculosis New (Priority Cases) Diseases for District) 30 Typhoid Fever All Others Tetanus (over 28 days age)

23 32 Sleeping Sickness 33 Pelvic Inflammatory Disease (PID) Total Diagnoses MORBIDITY SUMMARY-NUMBER OF PATIENTS TREATED AGE MALE FEMALE SUB-TOTAL 0-4 YEARS YEARS AND ABOVE TOTAL MORTALITY REPORT S.NO. SECTION NUMBER OF DEATHS CAUSE OF DEATH 1. Medical Maternity Pediatric Therapeutic feeding center Surgical TOTAL THE MOST PREVALENT DISEASES IN DECEMBER S. NUMBER NAME OF DISEASES NUMBER OF PATIENTS TREATED 1. Malaria Cough Intestinal worms 93 4 Skin Diseases 41

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