The Challenges of Covid-19

Whilst things have been tough here in the UK over the last 16 months, spare a thought for our friends in Uganda.

A rural road – but no-one on it!

Recent news paints a difficult picture.  Uganda is in a renewed lockdown for the whole of July at least, and Covid cases and deaths have been increasing. Many people are struggling economically because so many activities have had to close temporarily.  For poorer families this can lead to a shortage even of basic foods.

One medical director told us succinctly, “The hospital ran out of beds, oxygen, human resource, drugs, and our ambulance services were highly on demand.”

There are many medical challenges:  few people have received Covid vaccinations due to lack of supply, the oxygen supply is struggling to keep up with the demand.  There are shortages of other medication as the supply chain struggles to procure and deliver drugs and protective equipment.  Shortages include psychiatric drugs which can have a significant impact on those with mental illness. Many staff have been absent due to Covid which increases the pressures on those who remain.

Staff coping with the limitations from Covid

For hospitals, and particularly those in the not-for-profit sector served by Jamie’s Fund, there are additional challenges.  Hospital income, for example, has dropped significantly because people are putting off going to hospital, just as they did in the UK.  At the same time people are not being treated for potentially serious illnesses.  There are reports, too, of an increase in mental ill health which, again, has been seen in the UK, too.

For those with children, the challenges of home-schooling are considerable.  Although some families receive school work on-line, many families do not have access to the necessary (expensive) technology. Other schools have no equipment or skills to enable them to move on-line.

At Jamie’s Fund we are supporting where we can.  We continue to sponsor the seven Psychiatric Clinical Officers (PCO’s) that we have in training.  They have had a particularly difficult time, with their studies interrupted and other financial challenges.  

We are also considering what else we might be able to do but there is no doubt that there continues to be a huge need for mental health care in Uganda.  If you can help with a donation, of whatever size, please click here to donate.  

Taking services to those in the community

Bwindi Community Hospital has been providing care for people with mental illness since 2012.  We were invited to visit in 2013 and JF has been working with them since then.   One of the things that has impressed us about the hospital is that it’s vision extends to the community “A healthy and productive community free from preventable disease and with excellent health services accessible to all.” 

At Bwindi, they don’t just care for those who come to the hospital, as it is in some hospitals, but they are reaching out into the community to seek to enable everyone to be healthy and productive. This is a true public health approach.

The population around Bwindi are mainly poor subsistence farmers. Some are able to sell tea to the local factories, and the tourists coming to see the gorillas in the forest bring in some money. But in general, there is little cash in the local economy. People live on what they grow or sell in the market. Raising enough money for school or hospital fees is almost always a challenge. 

The mental health team, under the leadership of Kuule Yusuf, have been working out how to take mental health care to people who can’t get to hospital, for whatever reason.  Public transport is limited by the bad roads and the fact the hospital is literally at the end of the road, so there is no through traffic. There is little money available to pay for transport to clinic or hospital. 

There are 17 parishes for the population of around 70,000 and these were used as the basis of the new service.  Initially a monthly clinic was set up in each parish.  This was enabled by funding from Jamie’s Fund which provided a motor bike and protective gear, and also paid for extra staff.  This has meant staff spent quite a bit of time in community, staying out in two peripheral centres, when it was too far to travel back home each night, particularly when the roads are very muddy.  The result of the increased work in the community, the number of people attending clinics at least twice has increased from 288 to 693 per year

However, this model of care was dependent on staff from the hospital going out.  Kuule wanted the care to be available all the time, not just when staff were visiting.  Kuule asked JF to fund an mhGAP rollout workshop.  He trained staff from each of the health centres in the basics of diagnosis and treatment of mental illnesses.  

Waiting for the clinic

Kuule is completing an evaluation of the service, which we expect will be published.  This shows that the numbers attending clinics at least twice for mental illness have increased again to 839, since the training of the staff in the health centres.  This is very encouraging.

It has also show two issues which they are now working to address.  One is that only a few of the health centres are doing most of the work in mental health.  Some of staff who were trained have been moved to new postings, which means their expertise is lost to that community, others have not really engaged – sometime due to a lack of the appropriate medication.  The second issue is that about 40% of people attending a mental health clinic only attend once.  This needs further review to understand why this is and if it is appropriate.

Those in mental health leadership in the Ministry of Health in Kampala are very interested in this model of getting mental health care out into the community, as it could be replicated in other areas at relatively low cost.  

All credit to Kuule and his team for the services they are providing.

Jamie’s July Lifestyle Challenge.

Jamie

July 2021 is significant because it sees the 10th anniversary since our beautiful Jamie died.

In those 10 years we have continued to be inspired by his lovely, adventurous, playful nature. It is fitting therefore that we mark this poignant milestone with a fun lifestyle challenge that everyone can join, doing as much or as little as you wish or are able.

Over the last ten years Jamie’s legacy has extended far beyond our family and has touched many lives, particularly in Uganda. Jamie’s Fund, set up in Jamie’s memory continues the work in his name. We would like to encourage you, either as an individual or as a family, to join the Challenge and to aim to raise £200 or more. 

The Challenge will run through the whole of July. For the more active among us there will be some specific challenges that you can sign up to which have set targets  (such as walking 50 miles during the month, running 50 miles, swimming 10 miles or cycling 200 miles). These can be attempted individually or as a family or team of friends where each person banks some miles into the overall pot. If the set targets aren’t for you then we invite you to set your own target and we will cheer you on  (such as walking round the block every day for the 31 days of July, learning to swim, doing ‘dry’ July, losing half a stone or something else entirely).

Jamie’s Fund continues to provide amazing support for mental health in Uganda and with your help we are hoping to raise enough to continue to develop community mental health projects over the coming two years.

To join us in the Challenge, go to Jamie’s July Lifestyle Challenge Facebook page, and learn all about the ways you can get involved. Some of the challenges are listed under “Events”.

Avril Devaney

Why is epilepsy a problem we are involved with?

Joseph outside a rural health centre.

Mental health clinics in Uganda invariably include many adults and children with epilepsy. Part of the reason for this is the lack of neurology specialists in Uganda, and little capacity within general medicine, so these patients are usually seen by mental health services.

However, it is apparent too that epilepsy just seems to be more common in Uganda than we are used to in the UK. This higher incidence of epilepsy is confirmed by several studies. In fact, epilepsy is 2 to 3 times more prevalent in Sub-Saharan Africa than in industrialised countries. This may be due to factors such as higher rates of birth defects, minor brain injuries, parasitic infections and road traffic accidents. 

Children in the village waving.

In low income countries generally, the prevalence of epilepsy is higher in rural areas than urban ones. This might be due to having less easy access to maternal and obstetric health care, as well as for head injuries, in the remote rural areas. There is also the suspicion that town relatives with epilepsy might be sent back to the village. 

A 2018 study in south west Uganda found a particularly high prevalence (20.4 in 1000) in children. This reduced with age, especially over the age of 5 years. So do some children naturally ‘grow out of it’ or are there other explanations? We don’t really know.

Just as with mental illness, in Uganda epilepsy is assumed to be due to demon possession or witchcraft. And as with mental illness, stigma is high, and it is a cause of fear and shame if your child has seizures. Many families have no idea that treatment is available and effective.

Many children with epilepsy suffer burns as they fall into the fire during a fit, as cooking is usually done on an open fire. Stigma, injuries and burns, and the reaction of others, make the life of a person with epilepsy a very difficult one.  They may be excluded from school or employment.

Whatever the causes are believed to be, mental health staff have a critical role to play. Not only in offering medication as appropriate, but importantly in helping the parents and carers of those with epilepsy to understand it better, and to know how to keep their child or relative safe.

As the mental health teams work with such families, they can sometimes make a dramatic difference. In one family, the eight year old son had frequent fits, and it was judged that the father was the agent who was bringing in the demons who were the cause. Not only was the child excluded from school, but the father was sent away from the village. With treatment, the boy’s fits ceased and he was allowed to return to school. The team from Bwindi Community Church of Uganda Hospital helped the family and local people to see an alternative explanation, and the father was restored to his place in the home and in the community.

Linda Shuttleworth

Children waiting to collect water.

Looking after those in need.

From time-to-time we are reminded that Covid19 is not the only story in town and even more importantly that there are good news stories that have nothing to do with Corona virus.  A recent story from Georgious Orishaba, the psychiatric clinical officer at Kisiizi Hospital is a case in point.

In September, 2019 a lady was picked up from the side of the road by a passing well-wisher and brought to Kisiizi Hospital.  Here we call her Mary (not her real name).  Mary was 34 years old and suffering from a mental illness that meant that she was unable to tell the staff very little about herself, her family or where she came from.  What little she did know kept changing.

Later Mary remembered that she had worked a time for a member of staff from Kisiizi Hospital and so a little information about Mary became known.  She was also diagnosed with a range of issues including depression and psychosis associated with HIV as well as a number of other conditions. 

Over time and with treatment it became clear that Mary had been abused as a child from an early age and had not only lost one child but had also had two others.  As a result of this she had been blamed by both her parents and her employer and so it was she was eventually found at the side of the road.

Although Kisiizi is a not-for-profit hospitals, patients are normally expected to contribute towards their medical costs and to provide their own food.  For Mary this was a non-starter since she had no resources to meet any of the costs.  However, Kisiizi Hospital stepped in and supported Mary from September, 2019 until her eventual discharge in July, 2020.  After 10 months of treatment members of her family were finally found.  Unfortunately both her parents had died but we are pleased to report that Mary has finally become settled with her aunt.

At Jamie’s Fund, we are always delighted to hear stories about patients who have come through challenging times and are very pleased that, through the Jamie’s Fund investment in the Ahamuza Centre, Kisiizi is able to provide a certain amount of long-term care of this kind.  We are also aware, however, that the cost to the hospital of providing both medical and nutritional care is significant.  

There are many stories like this and Jamie’s Fund is pleased to support work with patients like Mary.  If you would like to contribute towards the work with people with mental health in Uganda, please click here.

Hugh Burgess.

Kilembe Mines Hospital; a Story of Resilience

Maureen and Simon with Sister Teopista, Amon, and Joseph Wakabi.

It seems like another world, but just over a year ago, as part of our last visit to Uganda, Maureen Wilkinson and Simon Tavernor visited a hospital in the foothills of the Rwenzori Mountains.  Kilembe Mines Hospital was keen to develop mental health care, recognising this as a largely unmet need locally. It was agreed that Jamie’s Fund would do what it could to support this. 

The Hospital was established back in 1951 to serve the staff of the Kilembe Mining Company and the local community. (Copper and Cobalt are the minerals extracted and processed here) It is now a joint venture between the Company, the Government of Uganda and Uganda Catholic Medical Bureau. It sits in the flood-prone Nyamwamba River valley, over 50 miles away from the nearest Regional Referral Hospital at Fort Portal.

in May, we heard that the hospital had been destroyed by a torrent of water, mud and boulders, washed down when the river higher in the mountains had burst its banks after unusually heavy rains. Buildings, medical stores and equipment had been washed away, as had the homes of staff and villagers. People were evacuated to temporary shelters.

We heard no more for a long time, and assumed that sadly that was the end of this hospital. However, just as we were commissioning the next mhGAP Train the Trainer workshop (to be run at Butabika before the end of the year) there was news. Kilembe Hospital had temporarily relocated to buildings in the nearest town, Kasese, and was up and running again!! Not only that, but they were eager to send two of their staff to attend the training and begin the process of expanding their mental health care service. 

We stand in awe of their spirit and resilience. 

Dr Diana Atwine and colleagues visiting the damaged hospital

Dr Diana Atwine, Permanent Secretary at the Ministry of Health, visited the site in October , and committed that the hospital would be rebuilt in a safer location.

Linda Shuttleworth

Good news and new challenges in Uganda

In most African countries there is no such thing as a welfare state. Families try hard to give their children a good education, with the hope that they will get well paid jobs and take over the support of the younger children – particularly the payment of school fees. 

Jane is the only girl in her family, the eldest of eight – seven brothers! She did well at secondary school, and with the hopes of her parents invested in her, she achieved a degree in accounting at Makerere, Uganda’s top university.

Jane got a job at a high performing accountancy firm. She was able to pay the school fees for her brothers, and to take good care of her parents. She thought she could now aim higher, and set out to gain a postgraduate diploma.

At this point when Jane’s life appeared to be going very well, she experienced some stress and her mood began to go down. She lost concentration and both her work and her studies suffered.

Then came a dramatic change in mood, which went up to way above normal, too active and overtalkative. When she became irritable and argumentative, that did it: she was immediately fired from her job.

“When someone has physical pain, they can go to the hospital and tell the doctor that I have pain here, but my challenge is that I had pain but it was not physical. I lacked the person to talk to, it was killing me silently” she says.

Bipolar disorder is a serious mental illness common all over the world. You can control the moods to some extent with medication, but talking about the illness and learning how to manage it is one of the crucial treatments. The mental health team at Mukono Hospital, supported by Jamie’s Fund, are great at offering time to talk as well as giving out the right pills.

Jane’s family didn’t seek treatment at first because they didn’t even know that what was happening with her was a mental problem that could be treated. They just looked on and when she was out of control, they locked her inside the house.

 “We saw it as an embarrassment in our family and we didn’t ever want the community to know about it” her mother says.

“It was only when a family friend told us about the initiation of mental health services that we went to Mukono Church of Uganda Hospital.”

Jane and her mother

As Jane eagerly agreed to treatment, so mum readily agreed to become an ambassador for mental health in her community, happily celebrating her daughter’s new life. 

After just two months there was a clear improvement and Jane was happy and well. She was continuing to attend the hospital for her regular treatment sessions, but as with most patients who live some distance from the hospital, it’s likely that the lockdown conditions will have prevented her getting her treatment at times. 

All of the teams supported by Jamie’s Fund face huge challenges in supporting their patients and enabling them to continue with their treatment. Not so many people in rural areas have access to phones – for on-line psychotherapy! – and they normally receive their medication from the team in the clinics at the hospital or village health centre. The results of the virus and especially the very strict lockdown, may be far reaching and far more damaging than anyone will be able to measure. 

Please remember people with mental illness and epilepsy in Uganda, and the teams who care for them with so much love and devotion. 

Lamet Jawotho and Mo Wilkinson

Bringing knowledge and understanding, restoring hope

Lubaga Hospital

There is no doubt that Covid19 has been, and continues to be, a challenge to our friends in Uganda.  It was therefore with “double joy” that we have received news of an mhGAP training workshop that has just been successfully completed at Lubaga Hospital[1], on the western side of the capital, Kampala, and the second oldest hospital in Uganda.

Twenty-four hospital staff took part in the five day workshop between the 12th and 16th October, 2020.  The course was facilitated by senior psychologist Joshua Ssebunnya, a longstanding friend of Jamie’s Fund, and his colleagues. Using a variety of teaching techniques, they worked with doctors and nurses from across the hospital to enable them to diagnose and respond appropriately to a wide range of mental health conditions.

Feed back from discussion groups

This was achieved through a mixture of teaching, group discussion and practical role-playing exercises.  Participants and hospital management rated the course a great success and noted that the participants, who were not mental health specialists, were “already feeling the importance of mental health …”  The report sent to Jamie’s Fund also noted that that the sessions were lively and that, in consequence, none of the participants dozed off!

In his closing remarks, the Hospital Executive Director thanked Jamie’s Fund for its support and expressed the hope that Lubaga Hospital will now set up a mental health unit within the hospital.  Already a WhatsApp Group has been set up to support those who were trained in this workshop and a Clinical Officer has been tasked to work with the Deputy Principal Nursing Officer to continue the roll-out of mental health care across the hospital.

Participants with their certificates.

The team at Jamie’s Fund are delighted with the success of this workshop and we are pleased to have been able to provide the funding.  The cost of each workshop varies depending on different factors (including whether or not it is residential) but the rough cost is around £4000 for the five days.  We believe this is money well spent, as the training of twenty or more clinical staff across a hospital can have a huge and disproportionate impact on the lives of many people.

Mental illness often presents in other departments such as A&E and maternity or as an apparently unrelated presentation at out-patients clinic. Without such training the diagnosis may be missed.  By training staff from these different clinical areas to recognise mental illness the lives of individuals can be improved and they can begin to hope again.  Investment in mhGAP training is thus a relatively low cost way of bringing care and relief to as many people as possible.

If you would like to make a difference to the lives of people with mental illness in Uganda by supporting the work of Jamie’s Fund please click here.

Hugh Burgess

[1] Uganda Martyrs Hospital, Lubaga is a private, not-for-profit hospital that was started in 1899  by Catholic missionaries. It  currently has 237 in-patient beds as well as a range of out-patient clinics. The hospital seeks to provide “quality, accessible and affordable healthcare services” across a wide range of specialties.

Crossing the line on the 200×100 Challenge

Well!

Thank goodness that Challenge is over (at least I speak for myself).  32 individuals or teams worked really hard during September to cycle 200 miles.  Everyone has completed the challenge and for the most part everyone enjoyed the experience.  I don’t know what the total mileage eventually completed was, but that’s rather less important than the total amount contributed to the work of Jamie’s Fund.  Over £18,000 has so far been donated, every penny of which will go towards the work in Uganda.

Three generations

The Challengers (the cyclists) completed their miles in many different ways.  Some did a few long trips while others tried to do a bit every day.  Some were on the latest racing or touring bikes while some did their miles in the gym or at home.  It really didn’t matter because the important thing was doing the Challenge in order to raise funds.

Many of the Challengers are not people I have met personally or even heard of before the Challenge but, nevertheless, I feel that we have somehow come together in our shared endeavour.  I was tempted to say “shared pain” but that would suggest that others found it as hard as I did which I suspect they didn’t.  For this old codger it was certainly an interesting experience labouring “up hill and down dale”. Actually one of the advantages for those who cycled outdoors (over those on a fixed bike) was that the pain of climbing hills was at least compensated for to some extent by the down-hill sections.  The longest non-pedalling stretch I achieved was about 2.5 miles, slowing only for the photo when going past a speed camera!  That was a glorious experience that made up for the climb to the top.  It will long be remembered.  No doubt each of the others will carry their own memories of the Challenge.

Some Welsh hills

As far as I can tell, everyone who took part enjoyed the experience and for a number of us it has been an opportunity not only to get back on a bicycle but also to continue to ride beyond the Challenge.

But we also remember WHY we did the Challenge which was to help people on the far side of the world who need help with their mental health.  With the support of so many generous donors, also from all over the world, Jamie’s Fund is able to continue the work through the hospitals and health centres who work with us.

And so:

To the cyclists (The Challengers) a huge THANK YOU.

To the donors who have given so generously an even bigger THANK YOU.

To the partners of Jamie’s Fund in Uganda who do work with those who are mentally ill goes the biggest THANK YOU of all.  You are the stars who make the difference to the lives of others.

Hugh Burgess

Chair of Jamie’s Fund

 If you would like to donate to the work we are doing,  please click HERE.

World Mental Health Day – 10th October 2020.

This Saturday is World Mental Health day, focusing attention on an area that is all too often ignored or low down the agenda in many situations.

As you know Jamie’s Fund is doing what it can to increase access to mental health care in Uganda.

We were asked this week to describe to those at a virtual conference the work we are doing in Uganda.  Prof Maureen Wilkinson and Joshua Ssebunnya, senior clinical psychologist at Butabika Hospital in Kampala describe our approach in this video. You may need to register to watch it and the quality isn’t great.  The echo was off-putting to the speakers and listeners.  The section on JF starts at 26 minutes 15 seconds.

Maureen and Joshua