Uganda: promoting community health in Gulu

01-10-2007 Feature

Labworomor health centre in Gulu district has made a remarkable difference in the lives of thousands of local residents and internally displaced people. However, the small four-roomed building that houses the clinic has not been spared by the 20-year conflict that has ravaged northern Uganda. Journalist Denis Ocwich reports on the ICRC's comprehensive effort to rehabilitate 13 dilapidated health centres in the region.

  ©ICRC/D. Ocwich    
  North-eastern Gulu. Patients queue at the ramshackle Labworomor health centre in Palaro camp. The ICRC is set to renovate the building and construct an 8-bed maternity wing.    
  ©ICRC/W. Akwat    
  Children draw water at a borehole installed by the ICRC in front of the health centre.    
  ©ICRC/W. Akwat    
  Gulu district. Traditional Birth Attendants undergoing safe motherhood training provided by the ICRC at the Lugore health centre.    
  ©ICRC/W. Akwat    
  Trento Kasuze (left), the Nursing Assistant at Labworomor health centre, sits with couples who have come for antenatal counselling.    
  ©ICRC/W. Akwat    
  ICRC medical field officer Florence Aneko uses a doll in her training of birth attendants at Lugore health centre.    

The government-owned Labworomor health centre has a rotted ceiling that is coming apart, cemented walls that are peeling, and a concrete floor and veranda full of holes and cracks.

When we checked in at about noon, over 20 people – mainly women and children – were patiently waiting to be attended to by two of the three ill-equipped medical staff at the centre.

Shivering on a wooden bench in front of the treatment room, her wrinkled hands resting on her knees, is a sick old woman about 60 years old. She has come for an anti-malaria injection. The drugs are available, but the number of patients overwhelms the two nursing assistants.

“Sometimes we come here and spend five hours before getting treatment,” laments the grandmother, who acknowledges the efforts of the two nursing assistants at the health centre.

 A fresh aura of peace  

Labworomor health centre, sandwiched in the middle of Palaro camp for internally displaced people (IDP) in north-eastern Gulu, provides a harsh reminder of what conflict can do to health services. Now that the region is beginning to breathe in a fresh aura of peace, the displaced are starting to pick up the pieces, thanks to the ongoing peace talks between the Joseph Kony-led Lord's Resistance Army (LRA) rebels and the government of Uganda.

Renovation of derelict health facilities is one of the top priorities on the agenda of the government. Consequently, the office of the District Director of Health Services (DDHS) has entered into agreements with both international organizations and NGOs to improve the health sector in the district. The government is also stepping up efforts to recruit and motivate health workers to work in remote and impoverished localities like Labworomor.

The DDHS has found a willing and supportive partner in the ICRC. As one of the leading humanitarian agencies working in this conflict zone, the ICRC has stepped up efforts to raise the health standards of war-affected communities in in Palaro, a sub-county of Gulu district.

“We are going to renovate Labworomor health centre and also build an eight-bed maternity ward,” says Rose Agengo, the health delegate from ICRC’s Gulu sub-delegation.

 Strengthening social responsibility through training  

The ICRC is building social responsibility by facilitating training of Village Health Teams (VHTs), Traditional Birth Attendants (TBAs) and Community-Owned Resource Persons (CORPs). This is part of the government's efforts to involve communities in the management of the health centres. These volunteers do not earn salaries, but receive tokens of appreciation – such as soap, T-shirts and boots.

The idea behind this voluntarism is to empower local communities to be in charge of their own health services and ensure proper drug supply.

“For instance, training of TBAs is part and parcel of safe motherhood and reproductive health,” Agengo explains. “We want to ensure safe and clean delivery of babies by recognizing possible problems during the pregnancy.”

To reduce the number of cases of malaria among pregnant women and infants, the ICRC gives out free Insecticide Treated mosquito Nets (ITNs) to expectant mothers. Men are also encouraged to accompany their pregnant wives on maternity visits. In appreciation of the men who embrace this still-despised practice, those who accompan y their wives get free ITNs at the first visit to the health centre.

During our lunchtime visit to Lugore displaced people's camp, we met a group of TBAs (aged between 30 and 60) undergoing a safe motherhood training session under a mango tree in front of Lugore health centre II.

Their trainer, Florence Aneko, the medical field officer for reproductive health at the ICRC Gulu sub-delegation, was using a plastic doll and artificial pelvis to illustrate how to handle pregnancy and delivery. Smartly garbed in pink gomesis (local attire) donated by the ICRC, the women listened attentively and took turns showing their obstetric skills using the doll and pelvis.

“We are now ready to support health workers because we have received a lot of training,” says Christine Lukwiya, who is chairperson of the Lugore TBA group. Since last year, 50 women have been trained to offer free services to pregnant women in four villages within the Owalo parish of Palaro.

Besides encouraging and helping pregnant women to seek the services of qualified health workers, the TBAs are spreading the word about post-natal care, immunization of children, and family planning among couples.

“Despite the war, the women in the camps are very fertile; people are producing very many children. Our work is to educate them on the benefits of having properly-spaced pregnancies/children,” observed Vicky Adokorach, the youngest birth attendant, aged 30 years.

 Distinct positive impact on the community  

The TBAs, who are facilitated by the ICRC with delivery kits, are already having positive impacts in the community. Among others, their efforts are resulting in more rural women visiting health centres during labour. An even larger number of women are making prenatal and postnatal visits to health centres. 

“There are women who used to deliver in their homes; they hated coming to health centres. But now we are seeing many of them turn up,” narrates a beaming Trento Kasuze, the 40-year-old male Nursing Assistant who has long braved insecurity and risked his life to run Labworomor health unit, sometimes single-handedly, sometimes without drugs and equipment.

The comprehensive health package from the ICRC is not restricted to Labworomor. Another 13 health centres in northern Uganda are benefiting from the organization's support. The ICRC's comprehensive package includes rehabilitating the dilapidated health centres, constructing the maternity ward, toilets and bath and fencing the compound.

The ICRC will also guarantee access to drinkable water, supply medicine when needed, train VHTs and TBAs, and develop the interaction and articulation of volunteers with the health centres (shared objectives, common target population for mobilization). The ICRC will provide joint weekly supervision with the district health team.

The ICRC is the only organization with such a large scope of activities in the health centres, bridging the gaps between emergency and development needs. These are significant steps to rejuvenate community health services in this war-ravaged part of Uganda.

“Even when the IDPs return to their villages after peace is achieved, this health centre will keep serving thousands of peasant farmers, " says Kasuze.