JOHN PAUL II CLINIC
Our clinic provides following services: OPD, HIV/ART care, sickle cell program, Maternity and mother child health services, laboratory services and others.
HIA started to offer medical services in 2012. Our first project was John Paul II. HIV clinic for children. Since then, we have widened the scope of clinical services to: Out patients services, HIV/ART services for all age groups, TB diagnosis and treatment, laboratory services, Sickle cell disease program, antenatal care, immunization program, ultrasound services, counselling and recently we have opened also maternity wing for the deliveries. The environment is neat and friendly and the team is professional and really caring.
Health Initiatives Association was accredited by Ministry of Health Uganda to offer HIV/ART services in 2012. Our main effort was to offer age tailored service especially to HIV positive children and adolescents. But the family centered holistic approach prevailed and the care is offered to all age groups of people living with HIV. Our care is far from only “prescribing antiretrovirals”. We offer full package of care including opportunistic infections treatment, monitoring of laboratory parameters, counselling sessions, linkage to social workers, index client testing, assisted partner notification and program for elimination of mother to child HIV transmission. End of March 2022 there were 620 active clients in HIV program, 47% are children and adolescents.
Sickle cell clinic
The systematic approach to sickle cell clients is generally missing in Uganda. After identifying this gap in health care, professor Zdenek Racil from Czech Republic came to HIA and started a fresh new program for sickle cell disease in August 2019. We offer adjuvant treatment and for indicated cases also hudroxyurea treatment, regular laboratory monitoring, transcranial doppler for early identification of strokes, treatment of complications, family counseling, family screening, linkage to OVC program where needed and much more. This program is funded by Ssuubo Foundation with special fundraising efforts of theirs CEO Martin Zidlik and professor Racil. The care is offered completely for free. By the end of March 2022 there were 267 clients in the program and 48 of them were on hydroxyurea treatment.
Out patient department (OPD)
HIA started to offer OPD services in 2017. This service is of good quality because of professional personnel and good diagnostic possibilities due to well equipped laboratory. As the community in our area is really poor, clients are not charged any additional fee apart of the consumed tests and medicines. Emergency room with the capacity of three beds allows us to treat also severe infections with intravenous medications and to observe the client during the working hours. Majority of cases can be handled as an out-patient. The most frequent diagnosis are malaria, respiratory tract infections, peptic ulcer disease, acute diarrhea, skin infections. OPD department handles in average 765 new OPD attendances monthly.
Our laboratory is well equipped due to collaboration with several crucial partners. Availability of CBC machine, biochemistry, CD4 machine, fluorescent microscopy and modern point of care tests improves the quality of diagnostic process and also monitoring of patients with chronic diseases infectious or non-infectious. It is not only about the equipment but also about continuous professional development of laboratory personnel which advances the quality of service.
The counsellor offers her services not only to HIV clients, but also to sickle cell clients and other clients in need of these services. Still, the most frequent sessions are pre and post-test counselling and intensive adherence counselling for HIV clients failing on treatment. Our counsellor works hand in hand with medical and social work coordinator to offer full holistic package to a client in need..
Maternity wing was constructed with generous help from Caritas Slovakia. Since June 2021 we offer following services: deliveries, antenatal care, neonatal care, immunisation program, management of other illnesses in pregnancy, cervical cancer screening and nutrition program. Daily running of these services is secured by 1 medical doctor and 4 midwifes, whose salaries are covered by our new partner Foundation Helping others.
Najja mobile clinic
Every alternating Tuesday HIA team conducts an outreach to Najja, which is 12km from our offices in Lubanyi. Travel costs for 80 HIV positive clients from that area were too high, so we offered to deliver HIV/ART services closer to them.
HIA has trained expert clients in HIV program and in sickle cell program as well. They are responsible for morning health talks to particular groups of clients, addressing not only the medical condition, prevention, myths, but also group related challenges. HIA has separate day for pediatric clients, adolescents, mothers and other groups, so the health talk can be tailored to them.
Some of the clients are enrolled to our care when it is late. If the condition does not allow the regular check up at the clinic, the team reaches out to their household and check the patient during the home visits. Palliative care and end of life care is very important not only for the patient but also for family members and caretakers. We have partnership also with spiritual leaders in our community, who often join our team during the home visits.
Almost half of the population of Uganda are children and adolescents below 15 years. That is why this is our main target population for the prevention. Apart of regular health talks at school, HIA organizes every Wednesday preventive program for younger children at our clinic porch. Through interactive approach, through games, workshops, stories, our focal person shares basic health topics with children. Every Saturday is dedicated to Adolescents’ reproductive health program in our community hall. Reproductive health package includes not only prevention but also testing and treatment of sexually transmitted diseases for free for this age group. To participate in these activities we attract them through music, ball games, board games and available library. Average attendance of these preventive programs is 40 for children and 30 for adolescents.
In Uganda, HIV prevalence rate among adults aged 15 to 49 is 5.4%. There are 98 000 children aged 0 to 14 living with HIV and 4300 of these children died in 2020 (UNAIDS Country factsheets Uganda 2020). Buikwe district has even higher prevalence of HIV, mostly because of two factors: risk behavior of fisher folks at Lake Victoria shore and commercial sex workers along Kampala highway. Adequate approach and care for children with HIV in rural areas was lacking completely.
These are the reasons why HIA has focused on HIV care and treatment and mostly pediatric population. Systematic care, including regular checkups, laboratory monitoring, OI treatment, counselling, linkage to social program and other services can increase retention and secure better outcomes. Drug adherence and good attitude towards chronic medication from the side of clients is required as well.
Why sickle cell?
Sickle cell disease (SCD) is a hereditary disease. As you can inherit the shade of your skin or similar face to your parent, the same way you can inherit sickle cell disease. 20% of population in Uganda are carriers of sickle cell disease genes. Carriers or traits do not present with the symptoms of the disease. If two carriers have a baby there is 25% chance that the baby will have symptomatic sickle cell disease. The prevalence of sickle cell disease in Uganda among the population is 0.7 to 0.8 %. This means that 20 000 to 25 000 children are born with sickle cell disease yearly. Unfortunately, 80 % of them die before they reach 5 year of age. Sickle cell disease is lifelong disease. The symptoms are caused by the abnormal shape of red blood cell – sickle under particular conditions. These sickle cells are prone to rupture and can block small veins in the body and can cause various problems, starting from excruciating pain attack, stroke, chest syndrome to organ damage and many more.
The other symptoms are chronic anaemia – general body malaise, shortness of breath, dizziness, inability to learn etc. Unfortunately, there is no systematic program focus on sickle cell disease in the country. These patients need regular follow up visits with prescription of chronic treatment, regular laboratory monitoring and psychosocial support. Modern approach to sickle cell disease at HIA is guaranteed by our partner Ssuubo Foundation. Apart of lifelong adjuvant medication we have started to use also hydroxyurea treatment in indicated cases. The efficacy of this new medicine is already tangible. The transcranial Doppler ultrasound helps us to be able to predict and avoid strokes in these children. Proper chronic care and treatment is offered completely for free.