HEALTH SECTOR

THE REPUBLIC OF UGANDA

MINISTRY OF HEALTH
ISSUE NO. 3 - MAY 2018 NEWSLETTER

4TH GLOBAL HEALTH

SECURITY AGENDA SUMMIT
Delegates call for collaboration
in public health emergencies

FREE IRREGULAR FEATURED

MOSQUITO NETS HEARTBEATS CONDITION
1
Campaign ends UHI starts treatment Obstetric fistula
Contents
3. Ministry of Health Top
Management
4. 4th Global Health Security
Agenda Summit
6. Cobalt-60 radiotherapy machine
installed
7. Mosquito net distribution
campaign ends
8. Ministry of Health set to roll-
out Rota-virus vaccine
9. Finding new tb cases by
targeting school children
10. Treatment of irregular
heartbeats starts
12. Pictorial
16. Featured condition: Obstetric
fistula
EDITORIAL TEAM
Vivian Nakaliika Serwanjja
Public Relations Officer
Abirahmi Kananathan
Technical Assistant
Communications
2
From the Editor
Esteemed readers,
I am delighted to bring you the 3rd edition of the Health Sector Newslet-
ter. I and the team are really encouraged by the feedback we receive from
our readership as this helps us to serve you better.
In this issue, we feature obstetric fistula, a condition that has shattered
the dreams and aspirations of many young women, badly bruised their
self-esteem and afflicted upon them pain and stigma. Whereas some
cases can be repaired, Kevin’s condition is incurable. Hers is a story of
resilience, endurance and hope against all odds.
Our cover article highlights the proceedings of the of the 4th Global
Health Security Assembly, which Uganda was honored to host last quar-
ter. The lessons, experiences and opportunities for Uganda as a country
as well as individual departments are really immense!
We also have updates from Uganda Cancer Institute and Uganda Heart
Institute on services that have been a challenge in the recent past.
As you may have realized, we have changed the layout of our newsletter
to make your reading experience even more exciting. Allow me take this
opportunity to thank the committed team that has worked tirelessly and
everyone who has contributed in one way or the other to make this issue
a success.
To you our esteemed readers, we highly appreciate your feedback and
hope that you enjoy this issue.
With warmest thanks,
Vivian Nakaliika Serwanjja
Public Relations Officer
Rukia Nakamatte Mbaziira Edith Nantongo
BCC Specialist CHC – OBULAMU?
Contributing writers Photographer
Kevin Nalubwama Sam Nalwala
Fistula Survivor Ministry of Health
MINISTRY OF HEALTH TOP MANAGEMENT

Hon. Sarah Opendi Hon. Dr. Jane Ruth Aceng Hon. Dr. J. Moriku Kaducu
Minister of State Minister of Health Minister of State
(General Duties) (Primary Health Care)

Dr. Henry Mwebesa Dr. Diana Atwine Dr. Charles Olaro

Ag. Director General Health Permanent Secretary Director Health Services (Clinical)
Services

Mr. Ssegawa R. Gyagenda

Under Secretary

3
Health workers monitor isolation
units during the MVD outbreak in
Kween District
(Photo Credit: WHO Uganda)

4TH GLOBAL HEALTH SECURITY AGENDA SUMMIT

Delegates call for multi-sectoral detect and control the spread of the outbreak within a
matter of weeks,” said Dr Matshidiso Moeti, WHO
collaboration in public health Regional Director for Africa.

emergencies During the MVD outbreak in eastern Uganda, the

key innovation was community engagement and

J ust days before the high level Global Health Security participation in the response. This was reiterated by
Agenda (GHSA) meeting, that took place between 25th President Museveni during the opening ceremony. “Once

“
and 27th October 2017 at Commonwealth trained and sensitized, communities
Resort, Munyonyo, Uganda was struck Health authorities can be a resourceful tool in controlling
by yet another Viral Hemorrhagic Fever and partners, with outbreaks,” he said.
(VHF) – Marburg Viral Disease (MVD).
the support of WHO,
The response initially faced challenges
The affected districts were Kween and were able to detect with myths and misinformation at
Kapchorwa, bordering Kenya. Three and control the spread the community level, uncooperative
people (one probable and two confirmed of the outbreak within communities, inadequate logistics, poor
cases) died. Another 316 people terrain of the area and presence of few
suspected to have come into contact
a matter of weeks,” -
partners on ground.
with the confirmed cases were followed- Dr Moeti, WHO Afro
up and monitored. However, active community
engagement, realignment of interventions, increased
Uganda last experienced a VHF outbreak in 2000, when partner presence and above all, improved information
425 cases of Ebola were diagnosed in Gulu district. Since flow from the treatment centers to the community were
then, there have been several infectious disease outbreaks, instrumental in winning over locals.
including Crimean-Congo Hemorrhagic Fever (CCHF),
Rift Valley Fever (RVF), cholera and malaria. Uganda More than 400 teachers, taxi operators, boda-boda riders,
continues to receive plaudits for effective surveillance, drug shops and restaurants were sensitized and involved
detection and response outbreaks. in disseminating information and providing hygiene
facilities. About 992 members of village health teams
“Uganda response has been exemplary. Health authorities (VHTs) were trained in MVD risk communication and
and partners, with the support of WHO, were able to facilitated to reach their communities members through

4
A cross-section of the delegates
to the GHSA meeting pose for a
group photograph
counselling, home visits and community dialogue
sessions. They also helped with surveillance, active
case search and referral of suspected patients to health
facilities.
L aunched in February 2014, GHSA is a growing part-
nership of over 64 states, international organizations,
and non-governmental stakeholders to contribute to a
world secure from infectious disease threats.
Minister of Health Hon. Dr. Jane Ruth Aceng stated,
“Hosting a meeting that deliberates on how to support
countries to build capacity to handle emerging and re
merging threats, in the wake of this running outbreak,
places us on top of the challenge.”
During the opening ceremony, President Museveni noted
that rapid population growth, movement into previously
uninhabited areas and environmental degradation have
disrupted the ecosystem and increased the risk of disease
outbreaks.
“Today’s world is highly interconnected and interdepen-
dent making it prone to faster spread of diseases. We need
to be more alert and vigilant in detecting and controlling
the outbreaks,” Museveni noted.
The GHSA meeting was held with the objectives to:
1) Build country ownership, strengthen multi-sectoral
collaboration, and promote integration of health se-
curity into routine national, subnational and com-
munity programs.
2) Encourage national governments to develop or
broaden frameworks to engage communities,
NGOs, the private sector, academia, development
partners and other agencies in GHSA.
3) Share good practices for enhancing and sustaining
GHS programs at national, subnational, and com-
munity levels.
Speaking at the closing ceremony, Prime Minister Rt.
Hon. Ruhakana Rugunda urged countries to come up
with innovative ways to secure funding for responding
to outbreaks.
The Senior Director of Global Health Security, Nation-
al Security Council, Admiral Tim Ziemer applauded the
leadership of Uganda in prioritizing health security.
The Director of Program Management at the WHO Re-
gional Office for Africa, Dr. Joseph Cabore said, “Pub-
lic health emergencies have a severe impact on families,
governments and economies.”
The meeting was attended by delegates from over 50
countries, as well as leaders of international organiza-
tions. The three-day meeting was held under the theme,
“Health Security for all: Engaging communities, NGOs
and the private sector.”
The meeting issued a declaration reaffirming a shared vi-
sion of a world safe and secure from global health threats
and consensus to extend GHSA until 2024 in order to
accelerate the implementation of International Health
Regulations.
The 5th GHSA meeting will be held in Indonesia in Oc-
tober 2018.
5
Rt. Hon. Dr. Ruhakana Rugunda
Patients waiting to receive radiotherapy
commissions the newly installed
services at Uganda Cancer Institute
Cobalt-60 radiotherapy machine

COBALT-60 RADIOTHERAPY MACHINE INSTALLED

Radiotherapy services restored at Uganda Cancer Institute

E dith Komurubuga, 45, was diagnosed with breast

cancer patient in December 2015 and received radio-
therapy treatment on a weekly basis at Uganda Cancer
Cobalt-60 radiotherapy machine which was installed at
Uganda Cancer Institute.

Institute (UCI). However, her world – alongside that of Officiating at the commissioning of the radiotherapy ma-
many other cancer patients – came crumbling down when chine, Prime Minister Rt. Hon. Dr. Ruhakana Rugunda
the country’s only radiotherapy machine broke down in underscored the importance of radiotherapy services in
March 2016. the management of cancer.

“When the machine broke down, I did not know what Minister of Health, Hon. Dr. Jane Ruth Aceng dispelled
was in store for me in the near future,” rumors about the low standard of the ma-
she said, her voice breaking. chine. “This machine, worth €664,830,
Cancer patients in
was procured by Government, with sup-
The cancer burden in Uganda increases Uganda regained hope port from International Atomic Energy
on a daily basis; the most common cases when Government, Agency (IAEA) and is a high-level and
being breast and cervical cancers among with support from ultra-modern machine with many capa-
women and prostate cancer and Kaposi bilities compared to the previously used
Sarcoma among men.
partners, procured machine,” she said.
a new Cobalt-60
When the radiotherapy machine broke radiotherapy machine IAEA Director General Yukiya Amano
down, there was a temporary reprieve which was installed noted that the restoration of radiothera-
when the country received a treatment py services in Uganda is cause for cel-
offer for some 400 patients from Nairo- at Uganda Cancer ebration. “I have been to several coun-
bi-based Aga Khan Hospital. Institute. tries in Africa and there are 28 countries
with not a single cancer machine. Ugan-
The breakdown of the equipment triggered a major crisis da is several steps ahead,” he noted.
to which Ministry of Health responded in two ways:
1) Planned restoration of services in the short term and Uganda serves as a cancer treatment hub for patients
modernization as well as expansion of services in from neighboring countries, including Rwanda, Burundi,
the country as an intermediate and long-term goal; Tanzania, Democratic Republic of Congo, Kenya, Soma-
2) Ensuring that patients receive support from Aga lia, Eritrea and Ethiopia.
Khan Hospital in Nairobi at no cost to Uganda – this
support saw a total of 120 patients (including Edith) Plans are being finalized for the procurement of a second
receive treatment from the hospital out of the 400 Cobalt-60 radiotherapy machine to serve the growing
offered. number of patients. It is expected to be installed in Mula-
Cancer patients in Uganda regained hope when Gov- go National Referral Hospital by December.
ernment, with support from partners, procured a new

6
A happy child walks away with his President Museveni hands over a
mosquito nets from a distribution mosquito net to a beneficiary during the
point in Kampala City LLIN Close Out event in Sheema District
MINISTRY OF HEALTH CONCLUDES
MOSQUITO NET DISTRIBUTION CAMPAIGN
T om Mugisha, 35, a father to triplets aged 14 years is a
brick maker and a resident of Ihandiro village in Bu-
botyo sub-county, Kasese District. However, every after
two months, at least one of his triplets is diagnosed with
malaria and loses at least three school days.
“Sometimes I don’t even go to hospital because I know the
laboratory tests will show malaria; I just go to the phar-
macy and buy Coartem,” Mugisha said, as he walked out
of the mosquito net distribution point in his sub-county.
Mugisha was advised by health workers at the hospital to
clear mosquito breeding sites, close windows and doors
in the evenings and always sleep under a mosquito net.
Mugisha is one of the 38 million Ugandans who benefited
from the just concluded free mosquito net distribution
under the ‘Chase Malaria’ campaign.
Presiding over the close out event at Kabwoohe Stadi-
um in Sheema District, President Museveni emphasized
the importance of community involvement in the fight
against malaria, and tasked parish chiefs to ensure proper
use of mosquito nets at household level. He urged com-
munities to test and treat malaria as part of the measures
to avert the spread of the disease.
“Malaria is a disease of poverty and a cause of poverty.
It has severely affected the annual economic growth of
Uganda,” he noted. The President added that Ministry of
Health and Ministry of Agriculture, Animal Industry and
Fisheries are working jointly to administer Larvicides in
valley dams in order to prevent the breeding of mosqui-
toes.
The campaign aimed to ensure that 85% of the popula-
tion has access to a LLIN and 85% of all nets distributed
are utilized.
US Ambassador Deborah Malac said that her country re-
mains committed to ensuring a malaria free Uganda.
This campaign was launched in Apac district in February
2017 by the Prime Minister Rt. Hon. Ruhakana Rugunda
to scale-up coverage and the use of LLINs. Under this
campaign, Government and partners distributed about
27 million nets across the country, one net per every two
people in a household.
Activities implemented as part of the campaign include
sensitization of task force committees at district and
subcounty level; training district technical teams, parish
chiefs and Village Health Teams (VHTs). These activities
were followed by household registration before LLINs
distribution.
This campaign was supported by the Global Fund, DFID
through UNICEF, USAID/PMI and Against Malaria
Foundation (AMF) and the AIDS Support Organization.
The estimated cost of the campaign was Ushs 97 billion.
These funds have been used for procurement of nets,
transportation, operations, logistics, behavioral change
communication (BCC), data management, among others.
7
 District Teams working
A child receives treatment at a cholera on creating plans to End
treatment center in one of the affected Cholera in Uganda during
refugee settlements the Stakeholders meeting

CHOLERA IN UGANDA
MINISTRY OF HEALTH SET TO ROLL-OUT
ROTA-VIRUS VACCINE
R ita Lubhoiyo, in Kyangwali refugee settlement in
Hoima district, says her one-year-old baby had
severe fever and diarrhea. “He cannot hold down any
cision to introduce the rotavirus vaccine on the routine
immunization schedule.

food he takes, he has become weak,” she said. Lubhoiyo “No child should die of diarrhea; diarrheal diseases can
is one of the many mothers nursing children with cholera, be prevented,” she said, adding that the ultimate target is
while several adults have also fallen prey to the acute to eliminate cholera altogether. She cautioned district and
diarrheal disease. local leaders who ignore practices of open defecation.

Several risk factors such as open defecation, poor san- The most cholera-prone districts are Nebbi, Pakwach,
itation and hygiene, and eating food or drinking water Hoima and Buliisa. In 2017, 265 cholera cases were con-
contaminated with feces are associated firmed in the country.
with the spread of cholera. Rural com- Uganda’s multisector
munities and urban slum dwellers are plan for cholera In June 2017, Uganda launched a multisec-
particularly prone to outbreaks. prevention, control and tor plan for cholera prevention, control and
elimination - launchedin elimination. This plan is in line with the
Working with partners, Ministry of June 2017 - is in line World Health Organization (WHO) strate-
Health responded to the outbreak by con- with the World Health gy for cholera elimination by the year 2030.
structing latrines, providing handwash- The plan emphasizes scaling up access to
Organization (WHO)
ing facilities, distributing information, safe water, sanitation and hygiene (WaSH),
education and communication (IEC)
strategy for cholera health education, health care services and
materials, sensitizing communities, and elimination by 2030. use of cholera vaccines in cholera hotspots.
intensifying surveillance.
Ministry of Health and Makerere University in collabo-
These interventions have now been supplemented with ration with John Hopkins Bloomberg School of Public
the expedited roll out the Rotavirus vaccine to protect Health organized this engagement to share experiences,
children under one year from cholera and other diarrhe- research and new strategies in cholera prevention and
al diseases, which are the leading direct cause of infant control. Acting Director General Health Services, Dr.
mortality in Uganda. Henry Mwebesa noted that 75% of the disease burden in
Uganda arises from preventable diseases.
Speaking during a stakeholders’ meeting on prevention, Prof. Rhoda Wanyenze, Dean of Makerere University
control and elimination of cholera in Uganda at Makerere School of Public Health, expressed excitement about the
University, Minister of Health Hon. Dr. Jane Ruth Aceng new interventions against cholera. The vaccine is a crit-
informed delegates that the Ministry is now focusing on ical intervention, especially for vulnerable populations,
health promotion and disease prevention hence the de- but will have to be combined with other interventions.

8
St. Charles Lwanga SS of Koboko District TB screening services provided
take on Corner Stone S.S. during the final with support from IDI during world
school debate in Arua district TB day at Boma ground in Arua.

TUBERCULOSIS
FINDING NEW TB CASES BY TARGETING
SCHOOL CHILDREN WITH MESSAGES

W est Nile ranks second in TB cases after Karamoja

region, with over 20 multi-drug resistant (MDR)
and one extensively drug resistant (XDR) TB patients.
Arua, like the rest of the districts in West Nile, is affected
by the current refugee crisis, with a refugee population of
over 800,000. This has increased the number of TB cases
in the district.

A lot of TB suspected cases are missed during regular

community outreaches because these often don’t target
key groups such as school children.

On March 24 2018, Uganda joined the rest of the world

to commemorate the World TB Day. This was an oppor-
tunity for Ministry of Health, Arua District Local Gov-
ernment with support from USAID Communication for
Healthy Communities through OBULAMU? integrated
campaign to scale up TB communication.
This was preceded by week-long activities such as school
debates, TB marathon, radio talk shows, community
drives and community outreaches.
that TB does not affect only old people. “It’s an airborne
disease which can be easily transmitted from one person
to another.”
Tuberculosis services such as screening and treatment
were scaled up in the region and as a result, a total of
3,498 were screened for the disease, 1,058 sputum sam-
ples analyzed and 43 clients diagnosed with TB and giv-
en treatment.

The debates were held in nine schools, reaching over
9000 children. Guidelines were shared with schools to
generate TB-related topics for the interschool debate
competitions. The debates were a platform through
which comprehensive information on TB was dissem-
inated with the supervision of the district health team.
Through this platform, the benefits of TB testing were
conveyed to the children.
Hellen Amaati, a student of St. Mary’s Adiofe who was
visibly excited to be part of the debate said she learnt
“For the first time in my region, I have witnessed mas-
sive awareness on TB targeting schools and the commu-
nity through the OBULAMU messages. This is a great
achievement to Ministry of Health and key actors on TB
like me.” Dr. Alex Alidria Zonal Coordinator TB/Lepro-
sy Program
There has been heightened TB response by several part-
ners in West Nile region all working towards a TB free
world.
9
An insight into the catheterization
laboratory at Uganda Heart
Institute (Courtesy Photo)

UGANDA HEART INSTITUTE STARTS

TREATMENT OF IRREGULAR HEARTBEATS
F or the first time in Uganda, the diagnosis of irregular patients that it is possible to treat abnormal heartbeats
heartbeats also known as Electrophysiology Study without opening the chest.
(EPS) and its treatment known as Radiofrequency Ab-
lation (RFA) was carried out on 11 patients at Uganda “During the EPS, special wires are inserted into the blood
Heart Institute (UHI). vessels and advanced up to the heart with the

RFA is the treatment of life-threatening irreg-19 % of heart

patients
worldwide are
visual aid of special X-ray cameras. These
wires pick up signals and patterns from dif-
ular heartbeats and is a non-surgical, mini- ferent parts of the heart,” she explained. “In
mally-invasive treatment. RFA uses high fre- Arrhythmias this way, we are able to identify the causes
quency waves to direct heat to the part of the (irregular of the abnormal heartbeats within the heart.”
heart causing the irregularity in the heartbeat heartbeats) cases
in order to correct it. A special form of electrical energy (Radiofre-
quency Ablation) is then delivered to stop the abnormal
This came as a blessing for 27-year-old Ratibu Kiyimba, electrical paths. This procedure has registered a cure rate
who had been battling arrhythmia (irregular heartbeats) of over 90% and eliminates the need to take drugs on a
for almost 10 years. “I struggled with this condition for daily basis to suppress the abnormal rhythm.
a really long time. However, the doctors assured me that
I will be cured. The introduction of these procedures at Arrhythmias constitute 19% of the heart disease burden
Uganda Heart Institute is a divine intervention,” he said, worldwide. At UHI, they comprise of 25% of the patients
smiling from ear to ear. seen on a daily basis. People with irregular heartbeats
present with palpitations (pounding hearts), dizziness
Minister of Health Hon. Dr. Jane Ruth Aceng assured and fainting, among other symptoms.

10
Hon. Aceng commended the expertise at UHI in conduct- • Closure of holes in the hearts of babies and adults,
ing these procedures for the first time in Uganda. • Diagnosis and treatment of blood clots in the lungs
“These interventions will go a long way in reducing med- and the heart.
ical referrals abroad and increase the competitiveness of
Uganda’s health sector in the region,” she added. The Ugandan team that performed these procedures was
led by Dr. Joselyn Rwebembera, the only one of her kind
For the last six years, UHI carried out the following pro- in Uganda. She underwent training and specialized in
cedures in the catheterization laboratory; this intervention. Patients who benefited from
• Examining blood vessels of the heart for
any blockages, 25 % of the
patients
these procedures were full of praises for Dr.
Rwebembera for saving them from a poten-
• Opening up blocked blood vessels of seen at Uganda tially-fatal condition.
the heart and inserting wire loops to Heart Institute
keep the vessels open, are Arrhythmias Notable among the achievements registered
• Examining and treating blood vessels in (irregular by UHI this year is the successful triple by-
the legs, heartbeats) cases pass heart surgery known as Coronary Artery
• Opening up blocked heart valves with- By-Pass Grafting conducted exclusively by
out opening the chest, Ugandan doctors. This procedure involves creating an
• Emergency placement of a device that stimulates alternative route for blood to parts of the heart whose
the heart to beat, blood supply has been blocked by a clot.
• Permanent implantation of a device that stimulates
the heart to beat, This complex procedure was another first of its kind to
• Diagnosis and stopping of irregular heartbeat from be carried out in Uganda. This, among many other inter-
inside the body, ventions has steadily reduced patient referrals abroad and
• Implantation of a special pacemaker that supports attracted patients from the neighboring countries.
and treats weak heart muscles in patients with ad-
vanced heart failure. In developed countries, this is Patients who benefited from these procedures thanked
used as a bridge for patients waiting for heart trans- Government for giving them a new lease of life.
plant,

11
MALARIA RESPONSE

ABOVE: President Museveni pledges

his commitment towards the Mass REGISTRATION OF BENEFICIARIES
Action Against Malaria (MAAM) under
the theme “A Malaria Free Uganda Is
My Responsibility”

SENSITIZATION

ABOVE: Members of Village Health Teams (VHT)

conduct registration of households ahead of the
Mosquito Net distribution exercise in Kampala City

LEFT: VHTs conduct sensitization of commu-

nities on how to hang a mosquito net
12
 FREE MOSQUITO NET DISTRIBUTION

ABOVE: Beneficiaries receive their

CLOSE-OUT mosquito nets from a distribution
point in Kampala City

SENSITIZATION

ABOVE: President Museveni addresses commu-

nity members during the Mosquito Net Distribu-
tion close out event in Sheema District

RIGHT: Teachers demonstrate how to hang a

mosquito net to pupils

13
 MDR TB TREATMENT

RESPONSE TO HIV & AIDS

ABOVE: Hon. Sarah Opendi
during the launch of the Short
Treatment Regimen for Multi-
Drug Resistant (MDR) Patients

SOCIAL RESPONSIBILITY
ABOVE: President Museveni launched Presidential
Fast-Track HIV Situation Room as part of the efforts in
ending AIDS by 2030

LEFT: Hon. Sarah Opendi receives Hospital Beds from

MTN Foundation intended to boost service delivery at
Bwera Hosptial, Kasese District
14
MARBURG RESPONSE

CAPACITY BUILDING ABOVE: Minister of Health Dr. Aceng (center)

receives motorcycles from WHO to boost the
response to Marburg outbreak in the East.

RIGHT: Permanent Secretary Dr. Atwine

signs scholarships awarded under Uganda
Reproductive Maternal and Child Health
Services Improvement Project to 184
beneficiaries from 13 institutions.

BELOW, RIGHT: Director General of Health

Services Dr. Mwebesa plants a tree during the
70th World Health Day celebrations in Luwero.

BELOW, LEFT: Communities in Kween

District undergo sensitization on Marbrug.

WORLD HEALTH DAY MARBURG RESPONSE

15
FEATURED CONDITION: OBSTETRIC FISTULA
O bstetric fistula is a condition of growing public
health concern in Uganda. About 140,000-200,000
(2%) women of reproductive age suffer from the condi-
tion. About 1,900 new cases are registered per year.
Although, 2,000 repairs are carried out every year, a good
proportion of women affected by obstetric fistula are not
receiving the required treatment hence leaving a massive
backlog untreated cases in the communities.
What is Obstetric Fistula?
Obstetric fistula is an abnormal opening between the
birth canal and the bladder/ureter or rectum of a wom-
an that results in constant leakage of urine and/or faeces
through the birth canal.
This is a complication which results from a tear in the
bladder, vagina or rectum. The pressure of the baby’s
head or any presenting part of the baby can injure the
tissue in the birth canal creating a hole between the birth
canal and bladder or rectum causing continuous, uncon-
trollable leakage of urine, faeces or both.
Most fistulas are as a result of difficult childbirth and ob-
structed labour lasting more than 24 hours.
What causes obstetric fistula?
• Prolonged or obstructed labour
• Teenage pregnancy
• Malnutrition
• Female genital mutilation (FGM)
• Sexual violence
• Infections
16
• Lack of skilled attendants
Symptoms of obstetric fistula
• Foul-smelling vaginal discharge
• Repeated vaginal or urinary tract infections
• Inability to contain urine or faeces
Who is at risk of obstetric fistula?
Fistula tends to affect the most marginalized members of
society; young, poor and illiterate women living in re-
mote areas.
Treatment services for obstetric fistula
Fistula can be treated with corrective surgery, and pre-
vented through mass education on female maturation,
safe sex practices, labor and delivery, health services,
and symptoms and treatment of fistula.
Government provides free treatment for obstetric fistula
in all regional referral hospitals in Uganda.
Points to remember
Obstetric fistula can be prevented and cured. However,
one must always adhere to the following;
• If a woman realizes she is pregnant, she should visit
the nearest health facility for proper check-up.
• During pregnancy, all women should attend all four
antenatal (ANC) visits.
• All pregnant women should deliver at the health fa-
cility under a skilled birth attendant.
• All mothers are encouraged to use family planning
method to space their pregnancies.
Kevin with her first born child (3
years old) in 2012
FISTULA: A SURVIVOR’S STORY
Obstetric fistula is one of the most serious and
tragic injuries that can occur during childbirth. It
is a hole between the birth canal and the bladder
or rectum caused by prolonged, obstructed labour
without treatment. The condition typically leaves
women incontinent, and as a result they are often
shunned by their communities.
K evin, 27, is living with incurable obstetric fistula and
has endured depression, shame and social isolation
for years. She shares her story.
“I’m a single mother of two, residing in Bujuuko along
Mityana road. I am a journalist by profession. I have
lived with fistula for three years. I got fistula as a result of
hospital delays, due to having one theater with only two
beds on the maternity ward. Yet there were many women
needed emergency obstetric care, at the same time.
However, I had other predisposing factors that put me
at high risk of getting fistula. I attribute these factors to
poverty caused by our father’s financial setback after he
failed to repay a bank loan in time. When the situation
worsened, Daddy went abroad. The bank confiscated
all our family property. We were practically left with no
starting point under the care of a jobless housewife, as
a single mother of five kids. We were deserted by our
relatives.
Kevin graduated as a
Journalist in 2013
Being the first born, I had to step in to cater for my sib-
lings. That was in 2005; I was in S.3 and 14 years at
the time. I got a casual job as a cleaner at the office of
the Deputy Director of Prosecution at Workers House in
order to pay for my fees. I would work from 6am-1pm
and attended school half day for three years (S.3-S.6). I
endured everything, until the situation was unbearable.
However, for fear of dropping out of school, it was about
this time that I gave in to Mr. X, into a conditional love
life of first giving birth for him, then he takes me back
to school. In 2008, after failing to register for my S.6
(U.A.C.E) exams, I took a dreadful decision and became
a victim of teenage pregnancy at the age of 17 years. This
landed me into child marriage.
As a teenage mother/ child marriage victim
As a teen mother, I faced a lot of challenges and went
through total hell on earth! But, I endured it all because
I had a target of resuming school – which I did – to
achieve my dream career in journalism. However, it was
extremely hard to juggle the roles of a mother, a wife and
a student.
But to sum it up all, I was never part of decision making
in my home from 2008, and for the rest of the 8 years I
lived in the marriage until we separated in 2016, one year
after getting fistula in 2015.
17
 Expectant Kevin before fistula with se
pregnancy in 2015
As a fistula victim - Experience, challenges and life
with fistula condition
In June 2015, at 24 years, I went to give birth to my sec-
ond child at Mulago Hospital, hoping that the process
would go well, since I had attended ANC four times as
recommended.
I was admitted on ward 5C at New Mulago with latent
labor which later intensified. After 2 days on ward under
constant monitoring, I was enrolled on the theater list due
to prolonged labor.
But due to the big numbers of patients awaiting C-section
on ward, who were in the same condition like me, I later
had an assisted vaginal delivery before taking me to the-
ater on the third day in labor.
Unfortunately, what seemed like a normal process in the
start, ended as futile labor, causing me complications like
several deep tears, paralysis of both legs and the entire
lower body part leaving me in severe unbearable pain.
After two days in this condition, I was discharged in a
wheel chair, since I was completely paralyzed and could
no longer stand up or walk without support.
A week after my discharge, I started leaking urine end-
lessly. I was re-admitted to Old Mulago, where I was
diagnosed with a Neurogenic bladder with a complex
nerve injury.
Hospitalization was too challenging without a care taker.
Stigma set in. With a foot drop and continuously leak-
ing urine even on catheterization, I completely lost hope
since no doctor assured me I would recover. This made
me believe that I was a total failure in life after losing my
job as a news anchor.
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Kevin nursing fistula and carrying her
new born baby on her back
At one point, I was nursed by my 6-year-old son who used
to empty my urine bag when I was abandoned by every-
one. I had no answer for his many questions: “Mummy,
why do you smell like sewage?” “Why do you wet your-
self and urinate on bed yet you are a big woman?”
Things turned from bad to worse when I got a severe
infection and started leaking pus. My son was psycho-
logically and socially tormented. He literally hated his
little sister whom he nicknamed “fistula baby”. I faced
more questions: “Mummy, why don’t you give back that
baby to the doctors, plus their sickness and we get dis-
charged?”
I sought further assistance from Kitovu Hospital in Ma-
saka. There was no difference in diagnosis. This is when
I accepted the reality and decided to live positively with
fistula. I was introduced to different coping mechanisms,
which have been fairly effective to the extent that cur-
rently, if I do not disclose, you may not tell that I have
fistula.
The coping mechanisms I use
• Timely emptying the bladder by using self-catheters
since I don’t get the normal urgely any urge to pass
urine.
• Padding all the time to avoid soaking my clothes in
fear of becoming a public nuisance.
• Extreme personal hygiene that I am forced to use
Omo (detergent) for bathing to avoid bad odor.
• Regular washing and changing of under garments to
avoid bad odor/ getting infections.
 Kevin, today, as a fistula champion

Besides medical mechanisms, I developed personal cop- discriminated against in all aspects of life to an extent of
ing mechanisms since fistula is now part of my life. being denied jobs, and being excluded from meetings.
• I restrict my eating; I eat once a day/ taking less
fluids to moderate the flow. Due to the lack of a job, at some point I go homeless for
• Sleeping for only 3 hours to avoid wetting the bed. failure to pay rent on time and have been thrown out from
• Smearing body oils before sleeping to prevent urine house to house.
from burning my skin.
But despite all the challenges I face, I am still ambitious
I developed personal coping mechanisms because I live and courageous enough to support the campaign to end
a costly life of using adult diapers to keep dry/ fit in soci-obstetric fistula.
ety. Besides, I also apply use tampons during my periods
since disposable pads and diapers alone can’t contain two As a Fistula Ambassador: Hope in Life (HIL) Initiative
flows at ago. However, although all of the
above coping mechanisms help me moder- As an “expert I am involved in advocacy as a Fistula Am-
ate the incontinence, they have caused me client”, I know bassador. Given the shuttered life I have
severe effects/ illnesses like ulcers, constant exactly what it feels endured as a teen mother, child marriage
headaches, and weight loss. like to live a fistula victim and as an incurable-fistula victim, I
life and would not chose to focus my efforts on helping to pre-
As a fistula survivor wish anyone to fall vent this tragedy, because prevention is bet-
victim. ter than cure.
Life as a fistula survivor is traumatizing and
too costly because I spend much of my savings on buying So as an “expert client”, I know exactly what it feels like
diapers/ tampons and treating recurrent infections than I to live a fistula life and would not wish anyone to fall
spend on other basic needs. victim. Therefore, I serve as a live example to the general
public but mostly to girls and young women. My expe-
Fistula rendered me jobless and a single mother of 2, rience inspired me to start up a development initiative
with one additional dependant, a young incurable-fistula called Hope in Life (HIL) to embrace the gift of life by
victim aged 17 years who I chose to take care of after she globally advocating against maternal morbidity to save
was deserted by all her relatives. the mothers and achieve safe motherhood for all, with
your support and funding.”
I live a vulnerable life where almost everyone around me
wants to take undue advantage due to my condition. I am

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