In July 2005 Kirsty Lawson spent a month in Uganda. Here's a report of her experiences.

The HIV/AIDS Challenge

The population of Uganda is 26 million. As many as 1,716,000 (6.6%) of these people have HIV/AIDS according to the World Health Organisation (WHO). This creates a huge demand on the health service for the treatment of opportunistic infections and for palliative care, and a real need for adequate HIV/AIDS education, counselling and testing on a national scale to reduce this.

Uganda is widely regarded as a nation that has recognised the enormity of the HIV/AIDS problem in sub-Saharan Africa and has taken steps to tackle it. Arriving in Kampala we saw billboards calling people to ‘Abstain, Be faithful, use Condoms’. This ABC approach, combined with education in the community and the availability of voluntary counselling and testing in the smallest villages in the Ugandan bush has reduced the prevalence rate substantially. However, HIV/AIDS remains a massive challenge for the many people infected who do not have access to treatment of infections or the money to pay for it, those who are in the last stages of the disease and need pain relief, the 1,400,000 orphans (having lost one or both parents to AIDS) it has created, the family members watching grandparents, parents, teenagers and children die.

Kiwoko Hospital

Every morning, people arrive having travelled for hours from their nowhere to this nowhere: a hospital surrounded by dense green bush, brilliant orange soil, round mud huts with thatched roofs and the smiling faces of men on bicycles, women working the fields and children playing barefoot in the dirt. Most people wait quietly in outpatients with malaria, whilst children with burns (fires made on the ground are easily fallen into and water boiling on them spilt) or severe dehydration are pushed to the front in the Ugandan equivalent of an emergency. Doctors stroll, patients are silent or stifling whimpers and I get the impression that these people have seen it all before, those that survive and those that don’t, and unfortunately the latter can outnumber the former.

Those that are admitted to hospital are required to have with them an attendant. The attendant is a family member or friend and will cook the patient’s food, feed them, wash their clothes and bed sheets (which the patient also provides) and at the end of the day will lay down on the floor at the side of the bed and sleep on the ward. If a person is ill but cannot be accompanied to hospital, they remain at home without treatment or look to witch doctors in the community (the mistakes of whom people often present to hospital because of). An attendant may not be found as the person would lose days of work, family land needs to be farmed – especially as many live off subsistence farming – and families often have many children that need to be looked after at home.

The wards are furnished solely with iron beds that extend in either direction in long rows with just a couple of feet between each bed. The only privacy is that afforded by the flimsy curtain that is wheeled round on a frame behind the doctor on the ward round. Patients make little noise or movement and do not object when they are told to move this way or that, regardless of the pain it causes them. I hear no complaints, no requests for information regarding their illness or when they’ll leave. Not an eyelid is batted at the standard of care at which I’m horrified.

Kiwoko HIV/AIDS work

During our month at Kiwoko Hospital, Andrew and I were heavily involved in the HIV/AIDS clinic and outreach work. Although our formal task was to compile a database of the details of all the HIV/AIDS clients, we also spent much time observing and aiding the running of the clinic, as well as the rest of the hospital.

We saw how patients arrived at the clinic drawn and wasted with blood pressures so low as to make you wonder a how they stay on their feet, and haemoglobin levels that would warrant transfusion at home, but a discharge here.

We met a teenage girl whose boyfriend had convinced her that although he is HIV-positive they could sleep together and she would not be infected. They did; she was. This is an example of the 72% of Ugandan 15-24 year old females who, according to the WHO, cannot ‘correctly identify two ways of preventing HIV transmission and reject 3 misconceptions about the transmission of HIV’.

We saw the families in which every generation is infected. The young parents look old aged and their babies are covered in sores. Mothers and fathers watch their children pass away. The working population is carved away and young and old are left to fend for themselves as providers become ill and die.

We met a 27-year-old woman whose family couldn’t/wouldn’t provide for her an attendant. She lay in her last days on a foam mattress on the floor of a small concrete room, barely moving or speaking. As she could not be taken to hospital, we couldn’t give her the medicines and care she so needed and we desperately wanted to give. We gave her 500mg paracetamol, less than I would take for a headache. There was silence in the van as we left.

We also witnessed all the good work being done. The various sponsors collectively provide a lunchtime meal for all those attending the weekly clinic, nutritious food (eggs, meat etc.) via outreach teams to those unable to travel to hospital, free consultations and drugs, mosquito nets to protect against malaria and special kits of plastic mattress covers/sheets, disposable rubber gloves, soap and other essentials for the patient and carers.

There is a community outreach team that puts on dramas and performs songs in neighbouring villages to tackle the stigma associated with HIV/AIDS and to encourage individuals to be tested. We spent a full day working in their practice room and only when we were leaving did we realise that every person there was HIV-positive. The lyrics roughly translated to, ‘Although we have HIV, we still have hope.’ I was so amazed by their strength, bolstered by the antiretroviral drugs (ARVs) – in routine use in the UK to add decades on to lives – recently introduced into Uganda. At Kiwoko, there is government funding for 100 patients to receive ARVs, which provides a huge ray of hope for the surrounding community. It means that people stay healthier for longer after being diagnosed, allowing them to support their families and enjoy life, and the community realises an HIV-positive person still has a lot to give and so gives them better support.

God moving

I could really feel God moving in Kiwoko. The staff and volunteers are so focused on improving healthcare, and the morning worship – a hundred beautiful African voices drowning out the guitar – renewed each day my desire to please God.

I have experienced so much personal development from being outwith my usual environment and thrust into another with such obvious suffering. For every one question that I have, a further five appear in trying to answer it. Why so much suffering? How was I born in England and not Uganda? What should my response to suffering be? How can I be of any use here? God has planted so many questions, so much compassion and so much anger at injustice in my heart that I can only hope He brings me back to a similar situation in the future so I can see some dreams realised.

Contact details

There’s so much more to write about and I’m looking forward to sharing everything face-to-face when I get home. If you want to reach me, please email me at kirsty.lawson@stjohns-burscough.org.