Health Centre turned into furniture store

Past the moving faces of kobs, lions, warthogs and elephants scattered throughout Queen Elizabeth National park in Kasese District, one cannot miss a signpost showing Kahendero landing site.

The narrow winding road leading there is just one of the many indicators of a community disconnected from the world. The other is Kahendero Health Centre II. Located 10KM off Kasese main road, it stands out as a two roomed building bolted with dark grey padlocks. There is nothing to warn a visitor that that the five year old health centre is now a furniture store.

Kahendero Health Centre II on the outside

It has been this way since its construction in 2008 according to the fishing community here.  

“Can you imagine we even close it with padlocks because it is now a store for people’s building materials and furniture!” ranted Musa Lukwago the chairman of the beach management unit of Kahendero village. 

The meant to be consulation room is now a store for furniture and plastic chairs

On the inside, stains of yellow paint severely scratched off the walls hint at the centre’s first beauty. Cobwebs cover the corners of the doors leading to the meant to be consultancy and treatment rooms. Dust swirled around the room as I made my way inside jumping over plastic blue chairs and iron sheets. The meant to be medicine cabin lay shattered on the floor and a loser look revealed unused garden forks and hoes.

The only hospital bed available carries wood plunks. Residents testify that the centre cost Shs 12m to construct.

For the over 4000 people living in this site, access to medicine and medical care is a far cry.

“When we become sick, we either have to go to Kagondo, Kilembe or Kasese hospitals that are about 13, 14 and 11 kilometres away. Many are reluctant to seek medical help because of limited transport,” Rehema Hakim, a village health team volunteer said.

She adds that Antiretroviral and anti-malarial drugs are most needed in this community because of the high prevalence levels of HIV/Aids and malaria. According to her statistics as of press time, 101 women and 60 men are living with HIV. A 2012 study conducted by the Uganda Fisheries and Fish conservation Association (UFFCA) revealed that HIV prevalence among fishing communities around Lake George and Edward increased to 22% compared to 19% in 2011.

Transactional sex was reported to be very common and the payment methods took various forms including fish for sex, shoes and alcohol and the overall mean age for the first sexual debut was 13 years. This prevalence is higher among the females because of multiple sexual partners-with one respondent mentioning 12 partners and only 13% of the 468 respondents used a condom every time they are going to have sex.

“Some of the reasons given for non condom use include lack of time, compromised sexual pleasure for both parties, no receptacle for disposal and their non acceptability in ritual sex,” the report findings read.

Hakim however says the complacency of Aids being another disease has settled in among the population so much so that some; especially men do not want to get treatment.

Three men have succumbed to HIV since the beginning of this year.

The treatment room being used as a store for wood plunks and iron sheets

“Lack of access to services and traditional social support networks in fishing villages means that people living with HIV who are too ill to work have to keep at their homes. This has implications for the spread of HIV and increases the number of people experiencing the impact of Aids,” Seremos Kamuturaki, the executive director of UFFCA said.

He urges government to establish a functional, well equipped and staffed health facility in Kahendero village. Another appeal is for government to economically empower the communities with other means of livelihood to avoid problems related to transactional sex.

WHO okays non-surgical circumcision devise to slow spread of HIV

The World Health Organization (WHO) last week prequalified a non-surgical circumcision device, PrePex that could delay the spread of the HIV/Aids pandemic.

PrePex is a disposable and easy-to-use device made of rubber bands. When applied to penis, the foreskin dies from a lack of oxygen and either falls off on its own or is easily cut off. This procedure is non-surgical, bloodless and requires no injected anaesthesia. 

 

WHO based its prequalification (a process to ensure that medicines, diagnostics and medical devices meet international standards of quality, safety and efficacy) of PrePex on a range of clinical data, including trials of the device in Rwanda, Uganda and Zimbabwe and evaluation of the manufacturing facilities and processes for the device. In a statement it (WHO) issued on Friday, it is estimated that if 80 percent of adult men in 14 priority African countries (with high HIV incidence and low rates of voluntary medical male circumcision) were to undergo the procedure by 2015, 20 percent of all new infections in men and women would be averted by 2025 in those countries.

Angelo Kaggwa, the program coordinator of the AIDS Vaccine Advocacy Coalition (AVAC) said that international donors have indicated a willingness to fund pilot studies and introduce PrePex for VMMC programs. However, African governments need to evaluate whether PrePex is a good additional option and develop policies and budgets to match.

 “This initial prequalification of PrePex is only for men 18 and older. One of the key next steps for PrePex must be to gather data on safety and effectiveness among younger men and adolescents,” he said adding that many men seeking surgical procedures are under 18 and there is need to provide them with a range of options.

Prepex was developed by Circ MedTech; an Israeli company founded in 2009 and was validated for the safety and efficacy by the Government of Rwanda and findings published in the Journal of Acquired Immune Deficiency Syndromes (JAIDS).

According to the WHO statement, the impact of PrePex and other non-surgical devices that could also be prequalified will depend on factors including the cost of the devices, quality and scope of data available to guide decisions about product introduction.

The cost of the device is reported to be $20 (Shs 52,000) which may be a barrier for widespread use. 

PrePex was first approved by the U.S. Food and Drug Administration in 2012 and certified by the European Union.

Landmark clinical trials in three Uganda, South Africa and Kenya in 2007 showed that voluntary medical male circumcision reduced HIV-negative men’s risk of HIV infection by at least 60 percent.

Dr Joshua Musinguzi, the acting Programme Manager of the AIDS Control Program said circumcision reduces the surface area for the virus to thrive.

“It is estimated that the removed foreskin reduces the surface area by about the size of the forehead and removes the Langerhans cells which act as receptors for the virus,” he said. The cells are found in the foreskin.

After circumcision, the area develops a scar and is therefore hard. This reduces the permeability capacity of virus.

Uganda’s position;

In its National HIV Prevention Strategy for 2011-15 and its HIV Prevention Action Plan, Uganda’s government has identified safe male circumcision as one of five priority evidence-based biomedical interventions and targets 4.2 million eligible men undergoing the procedure by 2015.

However, of the 1.2 million men that were targeted last year, only 380,000 were circumcised according to the ministry of health records and the 2011 Uganda Demographic Health Survey indicates that 24% of men in Uganda are circumcised.

To scale up efforts, the U.S. through the President’s Emergency Plan for AIDS Relief (PEPFAR) is offering support through funding, going from over $1.6 (Shs 4b) million in 2009 to over $31 million (Shs 80b) in 2012. It has supported more than 450,000 circumcisions in Uganda since April 2010.

 Currently, the Ministry of Health is spearheading a campaign dubbed, “Stand Proud, Get Circumcised” to educate the public and promote the uptake of safe male circumcision among men 15 years and older.