Saving Lives in Developing Countries. Charity Number 1081630

Rotary and Service to Freda Carr Hospital, by Dr Amos Odiit, the Medical Superintendant.

If one were to compose a song about Ngora Freda Carr Hospital (NFCH), the following words would be part of the lyrics – Ngora, the birthplace of many thousands, a relief hub for hundreds of thousands, a repair workshop for the torn and wounded sundry, an icon of its trade, and a meeting venue of God and man. The hospital, founded in 1922 by missionaries from England was once a Centre of Excellence for Surgery in East Africa during the mid-1980s. It lost its former glory after the insurgency that engulfed Teso Region in the late 1980s and early 1990s led to many health personnel and administrators abandoning the hospital, and eventually, with no maintenance, the infrastructure also got dilapidated.

Maternity unit, July 2018
Operating theatre, July 2018

As a young junior medical officer, I undertook my internship in this hospital in 1988, in the discipline of General Surgery. The situation in 1988 was different from what it had become: there were two Senior Consultant Surgeons, one Obstetrician Gynaecologist, a Consultant Paediatrician, four medical officers, and five intern doctors. The average number of surgical operations on a theatre day was 12, and there were three theatre days in a week. The different departments had many senior nurses.

With a deep sense of nostalgia and desire to help this hospital regain its glory days, I requested the Permanent Secretary of the Ministry of Health to post me to the hospital on secondment. I re-joined NFCH in September 2017 and found most buildings dilapidated, and other infrastructure broken down. There was only one junior medical officer and a surgeon who also doubled as the acting Medical Director. In 2017, It took three months to perform 12 operations (excluding caesarean sections) in the same hospital. There were now very few nurses, predominantly of certificate level, and the morale among all the staff was low.

Ngora Freda Carr Hospital Global Grant – GG#1745984    Luckily, some Rotarians led by Dr. Jim McWhirter from the Rotary Club of Reading Matins (UK) had visited the hospital in 2015 and were deeply touched by its deplorable state. In 2018, the Rotary Club of Kampala Central in partnership with several Rotary clubs from the UK (Reading Matins, Cardiff West, Harpenden Village, Marlow, Marlow Thames, Reading Abbey, Reading Maiden Erlegh and Thanet), Rotary Doctor Bank of Great Britain and Ireland and the Water and Sanitation Rotary Action Group started implementing a US$192,088 global grant project which supported the refurbishment of the maternity ward and operating theatre (plus equipping them), constructing a walkway between them, installation of a 16,000ltr water tank and supply of water to the maternity ward and operating theatre; and vocational training teams from the UK.

Maternity unit, July 2019
Operating theatre, July 2019

Two VTT teams that included midwives and a paediatrician visited the hospital and passed on essential lifesaving skills to the 681 tutors, student nurses, midwives and medical staff at the hospital and nearby Ngora School of Nursing and Midwifery (NSNM). That team also supported integrated community outreaches, a service that was long lost following the insurgency. We had anticipated more VTT visits but the COVID-19 pandemic prevented this from happening.

Human Resources for Health. Of the 119 hospital staff (29 from NSNM), we have a few specialists: one Paediatrician and one General Surgeon who are both fulltime, and a part-time Obstetrician/Gynaecologist. The others include three medical officers, two clinical officers, 22 nurses, six midwives, five laboratory technicians (one scientist and four laboratory assistants), two pharmacists, one dark room attendant and a part-time radiographer, two anaesthetic officers (one fulltime and another part-time), plus 27 serving in administration and support areas. This number represents only 52% of the required staff establishment.

Outcomes of Rotary Global Grant Intervention

Total annual Outpatients Department attendance increased to 10,544 after a declining trend from 2017/18 when it was 8,783. 

Total Antenatal Care attendance increased from 614 in 2018/19 to 875 in 2019/20. 

The use of family planning methods increased from 100 in 2017/18 to 247 in 2018/19, and 398 in 2019/20.  

Total annual inpatient attendance modestly increased from 2,498 in 2017/18 to 3,401 in 2018/19, and 3,580 in 2019/20.

Total annual deliveries realised a modest increase from 320 in 2017/18 to 425 in 2019/20.

Total under-fives hospital attendance was at 1,987 in 2019/20 but was yet to hit the 2,855 figure of 2017/18

An Obstetrician/Gynaecologist visits once a week and is available for consultation on phone at other times. Through our integrated outreach clinics, immunisation is carried out twice a week in the communities, while facility-based immunisation is daily. Our ratings from the government have improved, leading to the secondment of the second staff member serving as a medical officer. There has been an increase in funding from the Results-Based Financing framework and Primary Health Care funds from the government, which has enabled us to pay the health workers on time each month. Many are now happier as they work. We now attract clientele that can pay for our services, and their reviews are positive. That my friends is the power of Rotary and partnerships. We are also supported by the Uganda Protestant Medical Bureau.

Development of Ngora Freda Carr Hospital Global Grant – GG#2011733   Currently, only 63 of the 119 staff (52%) are accommodated at the hospital. The majority of the existing structures are completely dilapidated.

Derelict staff accommodation

This forces the staff to rent in the trading centre about 2.5km away. This poses a big challenge to the medical staff as they try to administer health care services to patients, many of whom include pregnant mothers and children.

We are overjoyed to learn that the Rotary Foundation has approved another global grant worth US$105,000 to fund the refurbishment of two staff houses and the floor of the Outpatients Department; provide mechanical and electrical works in the maternity ward’s private wing, and support another VTT. Just like in the previous grant, this is a result of a partnership between the Rotary Clubs of Kampala Central (Uganda), and that of Reading Matins (UK).  Decent accommodation is certainly an incentive in staff recruitment and retention, enhances the support supervisory function for administration and heads of units, and maximizes staff time for service by avoiding time lost in travelling to the hospital from outside accommodation. The private wing of the maternity ward, once completed, will also be a source of income for the hospital, which will increase the revenue and enhance the sustainability of the global grants. We look forward to the opportunity to have more staff accommodated at the hospital.

Centennial celebrations, 2022.    Next year, NFCH will mark 100 years of service to a rural population in Uganda. The hospital management and Board of Governors propose to gift the hospital with four items as part of the centennial celebrations: a 10-baby cot neonatal unit, a new chapel, renovated old chapel, and sculpture of Freda Carr, the girl after whom the hospital was named. Fundraising activities for the items are underway. Although the hospital suffered a major setback, we are certainly on the road to reclaiming its glorious past. Rotary has played a significant contribution to the recovery of services, particularly in maternal and child care.

On behalf of my workmates and the Board of Governors, I thank you dear Rotarians and invite you to be part of our centennial celebrations.

Dr. Amos Odiit.

Senior Consultant Paediatrician.

Medical Superintendant, NFCH.

This article appeared in the April Edition of the Rotary Magazine of District 9200, which covers Uganda and is reprinted with the permission of the Editor.