Kiwoko Hospital – Uganda
Located in rural Uganda, this hospital ministry serves a community marked by subsistence farming, lack of education, and diseases of poverty. Kiwoko Hospital provides inpatient care, including neonatology, surgery and obstetrics. The clinic also provides services for nutrition, eye, dentistry, TB, HIV and antenatal care. Kiwoko sponsors a community health initiative for immunization, public education, malaria prevention, water development and improved nutrition. The hospital also trains staff through their own nursing and laboratory school.
Four full-time physicians make up the medical staff, and are supported by many volunteer physicians who travel to Kiwoko each year. Students and residents fully participate in patient care, including ward rounds, night duty, presenting cases and assisting in surgery. Involvement with research projects is also an option.
Location & Community
Kiwoko Hospital is in rural Uganda, about a two-hour drive north of the capital. While life for the hospital staff is reasonably comfortable, most locals are poor and have received little formal education. Their average income is very minimal. Farming is the main occupation. The land is fertile and undergoes two rainy seasons in March and September of each year. The temperature ranges from 20-35 degrees Celsius.
Rural Ugandan families are large, and actively integrated with the extended family. Uganda is a predominantly Christian country. Many people attend church regularly, however Islam is growing slowly. Relations between Christians and Muslims locally are generally very good.
Most visitors to Uganda fly in through Entebbe Airport, which serves the capital city of Kampala. Airport taxis await all planes and easily take passengers into town. Kiwoko hospital can also arrange a hospital vehicle to transport visitors from the airport and bring them directly to the hospital.
All foreign citizens require a visa to enter Uganda. This should be obtained through the Ugandan Embassy in one’s home nation prior to departure. United States citizens can visit the Ugandan Embassy in Washington, DC. A letter of invitation from Kiwoko hospital is not required to obtain a visa. For resident doctors, registration with the ministry of health is officially required, and the Kiwoko medical director will provide guidance in this regard.
Traveler’s Health & Safety
Vaccination against DPT, Hep A & B are especially important. Also consider vaccination against meningococcus and rabies. Chloroquine-resistant malaria is present, and prophylaxis with mefloquine, doxycycline or malarone is generally recommended. One should consult with their personal physician before traveling, and refer to the CDC Travel Website for the most up-to-date health information.
Most of the patients are farmers with minimal education nor resources, some walk for miles with their infants on their backs to receive assistance. Patients usually bring an attendant with them who provides their basic needs: meals, laundry, washing, etc. Diseases that are typically encountered are HIV, malaria, pneumonia, and gastroenteritis. Tropical parasitic diseases are also common, as are traumatic injuries and obstetrical complications.
Most patients speak Lugandan, a tribal language. English is the language taught in Ugandan schools, however few patients speak English proficiently. Nurses are accustomed to interpreting for visiting doctors and students.
Medical Care Services
Kiwoko hospital is a 250-bed private not-for-profit hospital under the auspices of the Church of Uganda. Their motto is “We treat, Jesus heals.” Hospital wards consist of male and female for medicine and surgery, pediatrics, neonatal intensive care, and maternity. Clinics include general, nutrition, eye, dentistry, TB, HIV and antenatal. Clinical services are supported by radiology, laboratory and pharmacy. Surgical care is also provided.
HIV Care Services
HIV prevalence in Uganda was once among the highest in Africa. Today, this nation boasts the most significant decline in HIV prevalence in the entire continent. Leading the effort is Kiwoko Hospital with a comprehensive, community-wide prevention education effort. Community outreach teams commonly communicate this message through dramas and song.
Nevertheless, HIV infection remains common in Uganda. Kiwoko Hospital offers HIV and CD4 testing, Prevention of Mother To Child Transmission (PMTCT), antiretroviral therapy, home based care for HIV/AIDS through trained staff, nutritional support, orphan care, and hospice care for AIDS sufferers. The hospital also manages infectious complications of HIV, commonly including TB, meningitis, and toxoplasmosis.
Public Health Initiatives
Community health services include immunizations, youth clinics, public education, provision mosquito nets, latrine construction materials, water improvement methods and nutritional support. Efforts are being made to prevent transmission of HIV from mother to child. A home palliative care team also serves the community. The hospital supports a “youth friendly” centre for off site health education and weekly youth clinics. The hospital also trains staff through their own nursing and laboratory training school.
The Friends of Kiwoko Hospital, a support organization based in Northern Ireland, operate a website for the hospital: http://www.fokh.org.uk
Healthcare Profession Staff
Four full-time medical staff are usually present. Rory Wilson is medical superintendent. Dr. Wilson is a family physician trained in Belfast, Ireland. He also has a Diploma in Hygiene and Tropical Medicine from Liverpool University. Dr. Raul is a German-trained pediatric surgeon. In addition to hospital care, Dr. Raul is also a leader in community medicine. Dr. Peter is a Ugandan Surgeon trained in Kampala, who completed his postgraduate degree in Surgery in 2003. Like most Ugandan doctors, he is also experienced in medicine, pediatrics, neonatology, and obstetrics. Dr. Agnes is another Ugandan-trained medical doctor serving at Kiwoko. Physicians from numerous industrialized nations volunteer their skills at Kiwoko throughout the year, often for months at a time.
Kiwoko Hospital welcomes a variety of medical, PT, OT, nursing, resident physicians and other students each year. Each morning begins with a doctor’s meeting to discuss patients from the night and learning points. Students and residents are usually assigned to a hospital ward for a week at a time, with participation in outpatient clinics and community visits as well. Students are encouraged to be involved in the life of the ward, participating in ward rounds, presenting cases, assisting in surgery. Participation in research projects is also an option.
Inpatient numbers vary from season to season, the rainy season being the most busy. Pediatrics is generally the most active ward. Night duty varies according to the experience and expectations of visiting students. Resident physicians often do night duty per week, with a full-time physician available for question.
Student Lodging & Meals
The hospital has a training centre with 10 twin rooms for students. This facility also has a library, classrooms, and a dining room. In addition, a separate guest house is available for visitors.
Mobile phones and calling cards can be purchased in Uganda. Not all USA phones will work in East Africa. Mobile phone reception at present is poor at the hospital, though efforts are being made to improve it. Terrestrial phone connections do not exist. A satellite broadband connection is expected in the near future, and plans are in place for access terminals and an internet cafe for students and visitors. Phone reception in the capital Kampala is excellent, and internet cafe access is excellent.
INMED invites all participants to consider raising extra funds to donate to support this facility. While such efforts are not required, they will provide opportunities INMED personnel to become involved in this important aspect of international healthcare.
Students are encouraged to participate in the broader life of the Hospital community. Football is commonly played next door. The local Kiwoko market takes place on Saturdays. Church services are all within walking distance. Many students take advantage of their weekends in Uganda to visit game parks or the city of Kampala. White-water rafting on the Nile river is available, but nothing beats attending a bull-roasting in Kiwoko village!
Behavior & Dress
Rural Uganda is very conservative. Ladies trousers and dresses should not reveal any leg. In their own accommodation at home shorts can be worn. In the hospital, ladies should wear long skirts and males should wear trousers. White coats are the usual attire for doctors and medical students on duty. In Kampala or at safari lodges, Western-style dress is much more acceptable.
What To Pack
Visitors should bring copies of all healthcare profession licenses, diplomas, or certifications. It is also recommended to pack a carry-on bag that has essentials items just in case one’s luggage becomes lost. Bring clothes appropriate for the weather. Electricity in Kiwoko is not reliable; a flashlight with extra batteries is highly recommended.