Namulaba Update

Jan-Feb 2008

In this Edition
Directors message
Pg 2
Musisi speaks out
Pg 5
Wanakas
testimony Pg7
Namulaba visitors
Pg 9
Service Reports Pg
11
A patient being registered at the reception while
others wait for their turn
To reach Namulaba Health Centre (NHC) from Kampala you take Jinja
road and take a left turn at a trading centre called Namataba (35 Km
from Kampala). NHC is located 8 Km further inland on a dirt road. It is
in Nagojje sub-county Mukono District.
Services for HIV and AIDS Patients: A small but growing proportion
of patients are known HIV and AIDS cases attending routinely for
clinical follow up and refill of their supply of Septrin for prophylaxis of
opportunistic infections. Overall in the first six months 8.7% of the
patients seen were HIV and AIDS patients returning for routine follow
up. In addition to attending the medical clinic the people living with
HIV and AIDS (PHAs) also attend a support group meeting every
Thursday. (Continued on Pg 8)
I took another test in 2001 from
Mengo Kisenyi AIC Kampala but the
results were still positive. The
counselors of Mengo Kisenyi AIC
helped me a lot by counseling me and
giving me hope.
Aloysius Musisi.
The results came out positive then I
opened up a file and begun on
treatment. Although I accepted to go
for the blood test, I would go to
hospital secretly because I did not
want any of my family members to
know that I am HIV positive.
Florence Wanaka.

How about Malaria?

one of the excitements I
get out of this work is that
when a little girl is brought
with a fever I am able to
order a blood slide for
malaria parasites and if I
find the parasites I treat
the child using the
efficacious Artemesinin
Combination Therapy
(ACT). We are grateful to
AVERT to have made it
possible for us at
Namulaba to provide this
service which is not easy
for people to access
elsewhere. Director

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Jan-Feb 2008

1. Directors Message
Imagine you are a health worker who
works on HIV and AIDS but you have
bought land in a remote location, where
you think people do not know you, to
develop a retirement farm. What would
you do if when you reach your farm, you
find a sick looking woman with a 2 year
old daughter who has a high fever and
she asks you for help? She says she has
been told that you are a doctor and that
she lost her husband and her 2 year old
daughter has malaria and she herself is
sickly and she has no money. Do you
immediately put her and her child into
your four wheel drive truck, which you
came with because the roads were so
bad you could not use a simpler car,
and take her to the nearest hospital one
hours drive away? And what do you
think you would find there? I bet you
would find an outpatient department
that is operated by un-motivated underpaid staff. You would find that they are
short of basic supplies and medicines,
that their labs do not have the
necessary reagents and that the facility
is over crowded with patients and they
do not have a constant supply of
electricity and water.
Or do you tell her that you do not have
any equipment and medicines on you
and advise her to go seek health care at
the nearest public health facility? Or do
you give her some money and tell her to
seek care at the nearest private clinic? I
can not remember what I did but all I
remember is that I left with a very
depressed mind. I probably talked to
her about her problem and asked her to
seek care somewhere.
But that was a turning point in my
farming dream. I had bought this land
in a remote rural village called
Namulaba in Mukono district, located

one and half hours drive from Kampala

as an ideal place to develop my
retirement farm. And I was slowly
beginning to work on it each time I
came to my country, Uganda for
holidays. But now the people around
had discovered that I am a doctor. And
that I am a doctor who had worked on
AIDS in The AIDS Support Organization
(TASO), a kind organization that
provides AIDS Care and support at no
cost. For this reason, it appears, people
needing this kind of help were being
advised of the day I would come to the
farm and they would come and wait to
seek help from me. Indeed it was not
only that woman with her 2 year old
that approached me. Each time I came
over to the farm there were one or two
desperate people seeking such help
from me.
In my previous life while working in
Masaka Hospital (1985 to 1989) I had
provided primary health care to a
deprived rural community by the lake
side in a village called Buwunga. I used
to buy a stock of medicines and I would
go with them in a bag and operate a
clinic in the home of the parents of a
friend of mine called Peter. For a while I
thought of doing that at this new farm
place, Namulaba. But there were two
major limitations. One, I was not happy
with the quality of medicine I had
practiced in Buwunga because I used to
work alone with no other staff, I did not
have lab back up and I had a limited
variety of medicines. I had practiced
bush medicine and I did not like to do it
again. Second, the people in Buwunga
were wealthier and they could afford to
pay for the costs of that medical care on
a for-profit basis. But the situation I
was now faced with in 2004 in
Namulaba, was different. The people
were too poor to pay, even at cost price,

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for the care. So I could not repeat the
Buwunga service here in Namulaba.
After tossing these thoughts in my mind
I got a vision to build a health centre on
my farm land which I would operate as
a privately owned facility to provide a
public service using public funding.
And so on 5 February 2005 we laid the
foundation stone of the Namulaba
Health Centre. During the prayers that
were held that day at the site I publicly
made a commitment that the building
would be completed in two years time.
And by Gods grace on 30 June 2007,
only four months later than the dream
date, the building was operational and
we conducted the first medical clinic
and VCT service. This means that the
dream of having a health centre in that
location had become a reality.
There are certainly many friends we are
grateful to for turning this dream into a
reality. My own source of income,
namely my employer, the International
AIDS Vaccine Initiative (IAVI) was
crucial for this success. If I had not
been employed I would not have been
able to put up the structure. But the
structure alone would not have
delivered the services. We are very
grateful to AVERT: Averting HIV and
AIDS worldwide, a UK based charity, for
giving us a grant to equip the health
centre and provide primary health care
for the first year of the project. At the
time of writing, we are anticipating that
this grant will be extended for another
year as we work out a more sustainable
funding framework.
We have also been visited by a number
of friends who have given us highly
appreciated moral support, advice and
some material support. I will not be able
to mention all but permit me to mention
my four Swedish friends Mr. and Mrs.

Jan-Feb 2008

Ortendhal and Mr. and Mrs. Sund who

attended one of the drama competitions
and gave us some gifts; Bishop Paul
Luzinda of Mukono Diocese who visited
and blessed the building; my TASO
friends: Noerine, Peter, Jane and Elly;
and my WHO friend Sandra and her
daughter Janna.
From the need to provide care for people
like that lady who came with a two year
old girl who had a high fever, the
initiative evolved into a project to
respond to HIV and AIDS in this
community using a three pronged
approach as follows. First of all the
nucleus of the project is Primary Health
Care provided to all community
members regardless of HIV status. The
rationale for this approach was born out
of the reality that in a village with a
mature HIV epidemic, most health care
needs of a family are related to HIV and
AIDS. The ill person presenting for
primary health care could have HIV, or
s/he could be a care giver for an HIV
patient or could be a child of an HIV
positive client. Hence, the provision of
primary health care will most likely be
contributing to the relief of the family
from the suffering due to HIV and AIDS
and the associated medical and social
ills.
Also, although not so popular a view, it
hurts me to think that a little child or
an old woman should be left to die of
malaria just because they do not have
AIDS. Hence one of the excitements I get
out of this work is that when a little girl
is brought with a fever I am able to
order a blood slide for malaria parasites
and if I find the parasites I treat the
child using the efficacious Artemesinin
Combination Therapy (ACT). Once again
we are grateful to AVERT to have made
it possible for us at Namulaba to
provide this service which is not easy
for people to access elsewhere. Further,

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we provide HIV counseling and testing
and those found positive are provided
Septrin prophylaxis and are referred to
Kawolo hospital to seek ARVs. But they
also join the support group and
continue to attend the monthly medical
clinic for follow up and refill of their
Septrin supply.
The second prong of the project is a
comprehensive community response to
HIV and AIDS. To start with the project
started with community seminars.
These were overtaken by the annual
music, dance and drama (MDD)
competitions which climax in the final
competitions at World AIDS Day each
year. The MDD performances that took
place in 2006, before the
commencement of services at the clinic,
did make me nervous when they were
always depicting scenarios where HIV
testing and care were provided at the
Namulaba health centre. I was nervous
because the building was not yet
complete nor did we know where we
would get the money for the equipment,
supplies and personnel to run the
services. But we are grateful to AVERT
that they came in to our help.
The latest element to join the
community band wagon is the
community health workers. This fine set
of ten highly motivated community
members has started their work by
carrying out a hygiene assessment from
village to village. In each village the
findings from this hygiene assessment
are discussed with community members
and used as an entry point to discuss
general health issues including HIV and
AIDS. The CHW are using a special
approach where they engage individuals
to discuss with them personal HIV and
AIDS issues without the individuals
inviting them to. In other words rather

Jan-Feb 2008

than waiting for the clients to go to

them they go to the clients.
The third prong is the Namulaba
Network of CBOs (Community Based
Organizations). This network has 18
member CBOs that signed the
constitution in July 2007. Thereafter
the Network was registered in August
2007. Namulaba Health Centre is a
member of the CBO Network which has
an elected committee chaired by Mrs.
Margaret Kizito who is also the Speaker
of the Local Council 3 of the subcounty- a prominent person. I also seat
on the committee of the Network
representing Namulaba Health Centre.
The Network committee has the
responsibility to oversee all the non
clinical matters of the project including
the Music Dance and Drama
competitions and the work of the
Community Health Workers. They also
manage the user fees of Uganda Shs
1000 (about 60 US cents) per client
collected during the clinic. The aim of
the project is to gradually increase the
responsibilities of the Network as their
capacity to manage grows until such a
time that they can write proposals,
receive, manage and account for funds.
At the moment I am providing this
support from my private office in
Kampala and the Administrator at this
office is charged with the responsibility
of giving administrative support to the
Network while building their capacity.
Let me invite you to read and enjoy the
rest of the newsletter. Namulaba is one
attempt to cover the many gaps that we
have in our response to HIV and AIDS.
We are working towards an ideal African
village where everything that can be
done about AIDS is being done for every
person all the time. We are reaching just
a few people but with your support we
can reach more. Come and visit with us.

A Community AIDS Project based at a Not-for-Profit Health Centre

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Jan-Feb 2008

We have community health workers

training meetings and CBO network
meetings every second Saturday of the
month. You are welcome to join, listen
in and share. We have the medical clinic
and VCT every last Saturday of the
month. Depending on your skills you
can come and work as a volunteer
counselor, nurse, lab tech, clinician or
just a volunteer to guide traffic. The
clinics are heavy we usually have a 100

plus people. If you come before 9.00 am

you can join us in the prayer meeting
and you can also give a health talk to
the waiting clients. At any time you can
give us advice and you can also make a
donation.
Together we can make a difference for
the few that we reach.
Dr Samuel Kalibala
skalibala@hotmail.com

3. Musisi Speaks Out

In 2000 I was working with Coca Cola
as a sales manager. I fell sick, that is to
say I got a high fever and a herpes
zoster. I went to the clinic and the
doctor prescribed for me medicine for
the herpes zoster. By then my wife was
working in a pharmacy so I told her to
give me the prescribed medicine. She
got so scared after reading the type of
medicine the doctor had prescribed for
me then she told me that we might be
infected with HIV. She then suggested
that I go take a blood test.
I was staying in Bugiri town but I
decided to take a blood test from Kawolo
hospital because I never wanted people
in Bugiri to see me testing for HIV,
besides Kawolo hospital is near my
home village. After testing the doctor
broke the bad news to me that I was
HIV positive. I broke down, got so
worried and my mind was filled with
thoughts. When I told my wife that I am
HIV positive she became so furious and
bitter putting all sorts of blame on me,
she separated from me immediately. The
situation became worse because the
fever was not curing. I started getting
joint pains and I could not go to work
any more because I was becoming
weaker. The Managing Director Coca
Cola could not wait for me any longer so
he decided to give out my job. I could
not afford the rent any more since I was
jobless. Therefore I decided to go back

to my village area Masiko LC1, Wagala

parish, Nagojje sub county Mukono
District.
However I doubted the results from
Kawolo Hospital. I took another test in
2001 from Mengo Kisenyi AIC Kampala
but the results were still positive. The
counselors of Mengo Kisenyi AIC helped
me a lot by counseling me and giving
me hope. They told me that as long as I
live a positive life and take my
medication as required every thing
would be fine. I was referred to
Nsambya Home Care for treatment. I
registered with Nsambya Home Care
and
started
on
my
treatment
immediately.
I
found
transport
difficulties since I was staying very far
i.e from Masiko to Kampala I would
spend Shs10,000 and more which was
so expensive for me since I was not even
working. So at times I would not go to
hospital because of lack of transport.
Besides that, most attention was put on
people who stay around Kampala and
those who do not exceed ten miles.
Eventually I failed and gave up.
On learning that Kawolo hospital was
also treating HIV/AIDS patients, I
registered with them in July 2004. It
was an advantage to me because my
home village is not far from Kawolo
hospital. After registering with Kawolo
hospital, Dr.Kiyimba advised me to take
a CD4 test immediately because my

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condition was very bad. My CD4 results
came out showing that my White Blood
Cells were only105. So that was my
starting point. I started on ARVs but my
only prayer was that I do not get any
side effects.
When I went back to my community, we
formed up a group called Mukono
District Network of PHA Nagojje branch.
This group was counseling people and
sensitizing them about HIV/AIDS. The
coordinator of this group called
Mr.Musisi Gavah after realizing that I
was so interested in counseling others,
he
promised
to
help
me
join
organizations that can train me in
counseling and guidance. One year
after, I received a phone call from
Mr.Musisi Gavah informing me to go
and attend a training session led by
Hospice
Africa
Uganda
about
community
volunteer
workers
(Traditional healers in palliative care of
cancer and HIV/AIDS patients and their
families) where I was awarded a
certificate on 29thJuly 2006.
One month later on 22ndAug 2006,
Mr.Musisi Gavah called me again to join
Mild May and I attended a course in
communication and counseling skills
Still I was awarded a certificate.
In the same month he called me again
to join Mukono District HIV/AIDS
project where I trained to get basic
counseling skills. I was again awarded a
certificate on 30thAug 2006. The more I
joined those projects, the more I made
friends one of them being Mr.Byansi
Lawrence who is a coordinator of
MUMYO (Mukono Multi-purpose Youth
Organization)Mr.Byansi connected me to
Population Services International (PSI)
where I trained as a peer educator and I
was awarded a certificate on 12thNov
2006.
In April 2007, Mr. Musisi called me at
his home and he informed me about a
new organization that had come up

Jan-Feb 2008

called International HIV/AIDS Alliance

Uganda (IHAA). It wanted to train Net
work Support Agents as well as
counselors. Since I had a lot of interest
in counseling and HIV/AIDS seminars,
Mr.Musisi Gavah chose me out of the
many. IHAA went to Kawolo hospital
HIV/AIDS clinic to find out which
person would be recommended. Still my
name was given in.
From there, IHAA went to Mukono
District and asked the District HIV focal
person
Dr.Konde
who
also
recommended me. However two people
were needed i.e male and female
therefore
Mr.
Musisi
Gavah
recommended Namusoke Grace who is
now my colleague at Kawolo hospital as
NSA/counselor. I was awarded a
certificate by IHAA in community
engagement training workshop in
March/April 2007. After that training,
the IHAA connected me to PSI where I
was awarded a certificate in HIV basic
counseling and palliative care package
as a peer educator on 25thSept 2007.
IHAA has been giving us refresher
courses every after three months. I and
Mugerwa Badiru are the only people
that qualified as NSAs in Mukono
District. The criteria followed to choose
NSAs was;
HIV/AIDS training
Literacy skills, at least Senior
Four certificate
Managing workshops and other
forms of training
We were taken to the Lake Country
Club at Kiggo Entebbe road for training
as trainers. I was awarded a certificate
on the 12thOct 2007.
Before the IHAA, Dr.Kalibala Samuel
informed people of Namulaba that he
was starting up a clinic there and his
main concern was about treating the
HIV/AIDS patients. On the day of the
seminar at the clinic, I got a chance to
declare myself HIV positive and I asked

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Dr. Kalibala if I would join him in the
fight against AIDS. He gladly accepted
me to join him. That was when we
started
sensitizing
people
about
HIV/AIDS. We gathered here at the
clinic once in a month sensitizing
people about HIV/AIDS for a period of
six months.
Lunch was provided for the people who
attended the sensitization seminar. Dr.
Kalibala assigned me a task of following
up our clients. I would bring back the
report and the doctor would give me
some transport allowance.
When the clinic started operating,
Dr.Kalibala recruited me as an HIV
counselor.
I would like to take this opportunity to
thank him for being good to me and an
easy person to work with who does not
discriminate against any individual. My
God bless him. Currently I am the
coordinator of the Community Health
Workers at the clinic, I am also
responsible for training/facilitating the
community health workers and I am a
counselor at the same time.
My responsibilities include: Educating and giving awareness
on facts about HIV/AIDS and
issues on ARV treatment.

4. Wanakas Testimony
One time, around August 2005 as we
were on our village Kitto, we were told
that someone was planning to open up
a clinic in Namulaba.There was even a
seminar that day. Out of curiosity we
went to Namulaba to find out what was
taking place. We found many people
gathered at Namulaba. Mr. Aloysius
Musisi was talking about himself
declaring to the whole public that he is
infected with HIV/AIDS and that he was
on treatment.

Jan-Feb 2008

Advocating for stigma reduction

both at the health centre facility
and in the communities.
Through the referral system, I
guide individuals, families and
communities to service outlets.
Community follow-up of clients
taking ARVs in the community
and promoting adherence to
treatment.
I also do pre and post test
counseling at the health facility.
Providing adherence counseling
to clients on ARVs.
Carry out supportive counseling
both at the health facility and in
the community.
I mobilize people living with
HIV/AIDS
to
join
support
groups.
I would as well like to take this
opportunity to thank IHAA Uganda,
Chief of party Mrs. Milly Katana and
other IHAA staff including Mrs. Emily
Katamujuna, Dr Salome Nampewo,
Thomas, Peter (driver) and the whole
entire staff of the Alliance for their
support. We do appreciate. My wife
came back, we resolved our issues, we
are now happily married with six
children who are all HIV negative and
they all in school.
Mr. Musisi Aloysius

I was touched by everything Musisi had

said. When we went outside, I took
Musisi aside and I asked him where he
got the courage and strength to tell the
public about his HIV status. He asked
me to go to his home so that he could
tell me more about himself. I informed
him that my husband had died of AIDS
and I was afraid of going to hospital to
test my blood besides I didnt even know
where to start from.

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The following day, I went to Mr. Musisis
home. When I got there he counseled
me and convinced me to go for a blood
test. I became strong and decided to go
to Kawolo hospital for a blood test. The
results came out positive then I opened
up a file and begun on treatment.
Although I accepted to go for the blood
test, I would go to hospital secretly
because I did not want any of my family
members to know that I am HIV
positive.
I continued going to Mr. Musisi for
counseling who later on advised me to
open up and inform my family that I am
HIV positive. One time we were seated
at home with my sister and her co-wife I
opened up to them that I had tested for
HIV and found positive. I even told them
that I had registered and opened a file
in Kawolo hospital and that I was on
treatment. They were so happy about
what I had done, I felt relieved from a
heavy load. On that same day, I advised
my sister with her co-wife to go for blood
tests and they accepted. Good enough

Jan-Feb 2008

that very day was the first day of service

of Namulaba health centre so I went
along with them and they took the
blood tests. I carried on with advising
both the ladies and gents to go for blood
tests so that they can get to know their
HIV status. Whenever the health centre
operated, I would at least come with one
or two people and take them to the
counselor. People on my village started
consulting with me then I would tell
them the truth. I would like to thank
Mr. Aloysius Musisi who became a great
man and showed us the light. This is
the life I am living now. My thanks also
go Dr.Kalibala Samuel for what he has
done and his good plan. We are enjoying
the fruit of his good plan. We really do
appreciate your services at the clinic
which has turned us into what we are
now. Especially treating us for free
without paying a single penny. Inside
me I am filled with life both body and
soul. Let me finish by saying God bless
you.
Ms Wanaka Florence

Services for PHA (cont)

Some of the PHAs are receiving ARVs at Kawolo Hospital or Jinja Hospital. Kawolo
Hospital is the closest hospital located on the main road from Kampala to Jinja a
distance of about 10 Km from Namulaba Health Center. ARV services are provided by
the Joint Clinical Research Centre (JCRC) which is funded by PEPFAR to target widows,
orphans and PMTCT mothers and their families. Clients falling out of these categories
are charged Shs 20,000 to receive CD4 testing. At Kawolo Hospital also the MOH
program funded by the Global Fund provides free ARVs to all patients but does not
provide CD4 testing. Jinja Hospital is located about 50 Km away from Namulaba. It
provides free CD4 testing and the bus fare to and fro is Shs 10,000 thus some clients
find it cheaper to seek CD4 testing at Jinja hospital and then return to Kawolo Hospital
to seek ARV care.

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Jan-Feb 2008

5. Namulaba Visitors
American Missionaries
Other visitors

American missionaries, Jordan and Katie visited and ate lunch in a

hut on the farm on 12 June 2005 when they had come to carry out
missionary work in Namulaba village where they spent a week
living and eating in peoples homes. In the background can be seen
the incomplete health center building.

The Bishop of Mukono Diocese

Prof Elly Katabira, a

founder of TASO, visited
Namulaba at the laying of
the foundation stone on 5
Feb 05
Mr. Peter Ssebbanja, a
founder of TASO, visited
Namulaba at the laying of
the foundation stone on 5
Feb 05. He also later
visited during the drama
competitions on 2 Dec 06
Dr. Jane Mulemwa , a
founder of TASO, visited
Namulaba during the
drama competitions on 2
Dec 06
Ms Milly Katana the Chief
of Party of the
International HIV/AIDS
Alliance in Uganda, visited
Namulaba on the 15 Dec
07. In the morning she
participated in the training
meeting of the Community
Health Workers. In the
afternoon she attended the
meeting of the CBO
Network.
Dr Noerine Kaleeba, the
Founder and Patron of
TASO visited Namulaba on
the clinic day of 29 Dec 07.
She attended the Morning
Prayer meeting and gave a
health talk to the waiting
patients.

Bishop Paul Luzinda Kizito. He visited the health center building

on 24 Sep 2005 before it was completed and he prayed for it and
gave it a blessing. Here we see some Christians greeting him
while the Parish Priest Rev Ezekiel Michael Kafeero (in white robe)
and the Lay Reader Mrs. Esther Olya (in blue robe facing camera)
are looking on. Another Lay Reader (in blue robe back to camera)
looks on.

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Jan-Feb 2008

The visit of Mr. Peter Kanabus

Between 5 and 12 Dec 07 the
Director of AVERT, Mrs. Annabel
Kanabus and her husband Peter,
who also works for AVERT, were in
Uganda to visit Namulaba and other
HIV/AIDS organizations. The 8th Dec
07 was the day scheduled for
visiting Namulaba. On this day each
department of the project
participated in the show and tell.
The climax, as expected, was the
music, dance and drama
competition. Unfortunately, Mrs.
Annabel Kanabus missed all this as
AVERT visitor Mr. Peter Kanabus, husband of Annabel Kanabus she could not attend because she
the Director of AVERT, visited Namulaba Health Centre on 8
was taken ill and remained in
Dec 2007 and here he is being presented a gift by the Chair Kampala. But she was ably
of the CBO Network, Mrs. Margaret Kizito. Looking on is the
represented by Peter.
Chair of the Community Health Workers Mr. Kiyaga who was
translating between Luganda and English.

Mr. Peter Kanabus poses for a group snap with a cross section of Namulaba Health Centre staff
(Dr. Sam in neck tie), members of the CBO Network Committee and some Community Health
Workers. On the right side are school children and some community members who had
participated in the days music, dance and drama activities. In the background is the Health
Centre building.

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6. Reports by Departments

Number of clients seen in the first

six months of the health centre
The health centre provides medical
services and HIV Counseling and
Testing (HCT) at every last Saturday of
the month. During the months of June
to November 2007 a total of 704
patients were seen of whom 623 (88.4%)
received medical care and 234 (33.2%)
received HIV counseling and testing.
Please note that some clients received
both.
HIV Counseling and Testing (HCT)
Of the 220 HCT clients whose forms
were reviewed 19.3% were males and
80.7% were females. A good number
(42.1%) had been previously tested
while 57.9% had never been tested
.
Medical Conditions Seen June -Nov
07
The most common medical condition
treated was malaria which comprised
30.0% of the diagnoses. Malaria is the
most common cause of fever and fever is
one of the commonest presenting
symptoms of HIV disease. Most malaria
in Uganda is resistant to the commonly
used drugs (Chloroquine or Fansidar).
Thanks to the support Namulaba
Health Centre is receiving from AVERT
we are able to provide the efficacious
malaria treatment using Artemesinin
Combination Therapy (ACT) as per
government policy. ACT is only available
in a few government facilities which are
inaccessible to rural populations such
as Namulaba due to transport costs.
Following in order after malaria, is
respiratory tract infections which were
treated in 20.5% of the patients.

Jan-Feb 2008

before. For the current HCT sessions

provided at Namulaba, 22.0% received
individual pre-rest counseling, 73.8%
received group pre-test counseling and
4.2% (8 people) were counseled as
couples. However, the data on marital
status, shows that 45.0% of the clients
were married which suggests the need
for increased effort at encouraging
couple counseling.
The majority of the clients (72.8%) had
ever had sex while 27.2% had never had
sex. Of those who had ever had sex,
77.3% said they had had sex in the past
six months and of these only 22.9%
said they knew the status of their
sexual partner. This data suggests the
need to encourage disclosure and
sexual partners to seek HCT and to
share knowledge of HIV status.

Cough is another major clinical feature

of HIV disease. It is also the main
presenting
feature
of
pulmonary
tuberculosis
whose
incidence
is
documented to be higher in people
living with HIV and AIDS. Patients
presenting with cough of more than
three weeks are referred to Kawolo
hospital for sputum examination and
chest x-ray to exclude tuberculosis.
Next in order are peptic ulcers which
were seen in 9.8% of patients.
Dermatoses or skin lesions were seen in
9.1% of patients. Fungal skin infections
and other forms of rashes is a known
HIV and AIDS clinical feature. Next in

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Newsletter for Namulaba Health

12 Centre

Jan-Feb 2008

order are intestinal worms diagnosed in

7.9%
of
the
patients,
pelvic
inflammatory
disease
in
7.4%,
hypertension diagnosed in 7.1%, joint
pains in 7.1% and urinary tract
infection in 5.9% of the patients.

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Newsletter for Namulaba Health

13 Centre

Jan-Feb 2008

.
People Living with HIV and AIDS
The PHA support group is being led by
Mr. Aloysius Musisi who is a person
living with HIV and AIDS who has been
trained in HIV counseling by a number
of organizations including TASO, Mild
may
Mission
Hospital
and
the
International HIV and AIDS Alliance. He
is currently working part time at
Namulaba Health Centre as a counselor,
he also works at Kawolo Hospital as an
ARV counselor and he has also been
designated by the International HIV and
AIDS Alliance as a PHA Network
Support Agent (NSA).
The Waggala HIV support group
consists of PHAs who have been
recruited from individuals who were
either tested before Namulaba Health
Centre started offering services or those
who have learnt that they are HIV
positive
from
receiving
HCT
at

Namulaba. All those identified as

positive are referred to Mr. Musisi who
introduces to them the idea and offers
them to attend the Thursday PHA
support group. By Nov 07 the
membership has grown to 40 including
11 male and 19 female adults as well as
6 male and 4 female children under 18
years of age. Among these are two
Community
Health
Workers
of
Namulaba Health Centre.
The Waggala HIV support group works
on creating awareness about ARVs
among PHAs, giving them information
about the availability of CD4 testing as
well as ARVs at Kawolo and Jinja
Hospitals. They also explain how these
services can be accessed and where
possible escort fellow PHAs to seek
these services. They also provide
ongoing support to each other to ensure
ARV adherence and coping with living
with HIV and AIDS.

Religious Counseling
The need for religious counseling was
identified at the very beginning during
the formative community seminars that
preceded the services of the Health
Centre. The community members were
of the view that one of the reasons HIV
had spread was the degeneration of
religious morals. The Parish Priest for
the Anglican Church has spearheaded
this area of work by making himself
available to provide religious counseling

on Thursdays when the PHA support

group meets at the Health Centre. In
the months of Aug to Nov he was able to
deliver this service to a total of 62
clients. He has also reached out to the
leaders of the other major religions in
the community and is preparing a
training meeting for them to take place
in January 2008. It is hoped that the
other religious leaders too will be
attracted to deliver this service to
clients of their faith.

CBO Network
In the formative phase of the project a
mapping of CBOs present in the
community was carried out. It was
observed that 22 CBOs of different

capacities
were
present
in
the
community but none or few of them had
managed to carry out any activities
owing to resource and capacity
constraints. It was decided that a

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Newsletter for Namulaba Health

14 Centre
Network of these CBOs would be
formed. On 21 July 2007 this network
was formed with 18 founding members
and it was officially registered with the
Government in August 2007. A
committee was elected and the Chair
Person is Mrs. Margaret Kizito who is
also the Speaker of the elected Local
Council of the sub-county. The CBO
Network committee meets every second
Saturday of the month. So far the
committee has successfully recruited a
team of Community Health Workers.
They have also resolved that they will

Community Health Workers

The Community Health Workers (CHW)
were
selected
among
community
members
by
the
CBO
Network
Committee. The selection was based on
written applications submitted in
response to a community advertisement
put up by the CBO Network. The main
criteria used for selection was the
ability to understand English and
Luganda as well as previous training or
experience in community work. Twelve
were selected, two (one male and one
female) per each of the six parishes of
the catchments area. Their training
comprises
of
a
half-day
training/meeting
on
the
second
Saturday of every month. It was started
in October and is expected to go on for
six months. In the four weeks before
they return for training, they carry out
two types of activities.

Hygiene Survey
This is carried out by the whole group
of CHW visiting one parish for two days
and going home to home assessing the
level of hygiene. On October 8th and 9th
the group visited Waggala Parish where
they reached 87 homes. Ventilation is a
major hygiene issue because a lack of

Jan-Feb 2008

use the user fees collected at the clinic

to build a community pharmacy and
maternity building. So far they have
procured a building plan for this
structure. It is planned that the
Network
is
increasingly
given
responsibility to manage the resources
provided to Namulaba Health Centre. So
far they have successfully managed and
accounted for the funds used to carry
out the Music Dance and Drama
competitions around World AIDS Day in
December 2007.

One is a hygiene survey and the other is

the
provision
of
individual
HIV
counseling in the community. The
training session is more or less a
meeting. It starts with a reporting and
discussing of the hygiene work and the
individual HIV counseling done in the
previous four weeks. This is followed by
a teaching/discussion on a chosen topic
and lastly a work plan is made for the
next four weeks.
The CHW are volunteers and they do
not receive any salary for this work. But
they are given a transport refund for
coming to attend the training session
and for going to carry out the hygiene
surveys. They are also provided meals
for the two days they spend in the field
doing hygiene surveys each month. As a
way of motivating them, they have been
provided T-Shirts, bearing project logos,
and gum boots.
adequate ventilation increases the
chances of transmission of tuberculosis
among
people
in
that
house.
Tuberculosis is a major opportunistic
infection for people living with HIV and
AIDS. The CHWs found that in 46 of the
homes visited the residential houses
had adequate ventilation while in 22 it

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Newsletter for Namulaba Health

15 Centre
was not enough and in 15 there was no
ventilation at all. A good supply of clean
water is vital for reducing diarrhea
which is a major affliction of people
living with HIV and AIDS. The CHWs
found that in 71 of the homes the water
was collected from piped wells, in 6 it
was collected from a running river and
in 5 from a pond. They also found that
in 44 of the homes the drinking water
was boiled, in 3 it was filtered but in 33
of the homes nothing was done about
the drinking water. In the homes where
the CHWs find gaps in the level of
hygiene they educate heads of the
households about the need to meet the
hygiene standards and the CHWs go
back to check on improvements.
In addition to helping to improve the
hygiene of people in the community the
hygiene work has emerged as an activity
that has helped the CHW to establish
their credibility as people concerned
about the health of the community. It is
the view of the CHWs that this will
function as a launching pad for their
AIDS specific work.
HIV counseling in the community:
The CHW are being trained to be able to
engage
community
members
and
discuss HIV and AIDS issues. In the
four weeks between the training

KABP Survey
In December 2005 a baseline survey of
HIV Knowledge, Attitudes, Behaviors
and Practices (KABP) was carried out.
This survey was repeated in Dec 2006
and has also recently been conducted in
Dec 2007. The survey has
demonstrated a slight rise, between
2005 and 2006, in knowledge about
mother to child transmission, a rise in
those who mentioned condoms as a
means to protect from HIV but a fall in
those who mentioned abstinence or

Jan-Feb 2008

meetings they make attempts to engage

community members in HIV counseling.
They report these encounters during
the CHW training meeting and highlight
the challenges they met and other
CHWs together with the facilitators
discuss
how
to
address
these
challenges. For example, at the training
meeting of 17 Nov 07 a CHW reported
how she decided to visit a lady and her
daughter who was ill and yet they had
cut themselves off from the rest of the
community. She visited them and learnt
that while the older lady believed that
she had got HIV from her daughter, out
of nursing her, she did not want to go to
be tested. She discussed with them
about how to seek HIV testing. At the
training meeting of 15 December
another CHW reported that he had used
his position in his church as the Youth
Pastor to engage young people to talk
about HIV and AIDS and to seek HIV
testing. He reported that his main
challenge was how to answer the
question on what happens to one after
testing positive for HIV. In the training
meeting of CHWs this issue was used to
launch into a discussion about what
CHWs should say with regard to
available services for HIV positive people
including ARVs at Kawolo and Jinja
Hospitals.
faithfulness. In terms of reported
behavior there was a slight rise in those
who had abstained for more than a year
and those who reported condom use.
These interesting results will be further
compared to the Dec 2007 KABP survey
which is currently being analyzed.
Further to this, qualitative research
may be carried out to verify or clarify
the observed trends.

A Community AIDS Project based at a Not-for-Profit Health Centre 15