Life in All Its Fullness John 10:10

“Life in all its fullness” John 10:10

KISIIZI UPDATE SEPTEMBER 2016

“to the ends of the earth...”

Started in 1958, Kisiizi has never closed its doors to patients. It is unusual in its rural location as most hospitals are placed in centres of population. And yet in spite of its remote site and the challenges faced by hard-to-reach areas Kisiizi has continued to grow and develop:

A]SPIRITUAL LIFE OF KISIIZI

Kisiizi continues in its goal to be faithful to the Great Commission and to be light and salt in our community. We continue to have morning prayers for Staff on weekdays and two services on Sundays. We hope to be able to enlarge the chapel as its current capacity is too small. Sharing with patients and their attendants continues and is much appreciated. Discipleship, training and fellowship meetings occur throughout the week and periodic missions have been fruitful. We seek more integration with the Diocese for mutual benefit and growth and see the linkage between health promotion and evangelism as being one way to authenticate the Gospel message. We held a Mission in August “Your attitude should be the same as Jesus Christ”.

B]CLINICAL SERVICES

The newly refurbished Maternal & Child Health Clinicis now fully operational. This project was supported by All Souls Church, London where Dr. John & Doreen Sharp lived prior to their time in Kisiizi. This facility gives us more space to open a post-natal clinic and facilities for the ante-natal mothers and a much better environment for both patients and staff. The Mother & Baby point HIV service is also located here.

Visiting teams continue to enrich our services. We continue to welcome Dr Keith Waddell and the Ophthalmology team from Ruharo Hospital in Mbarara for regular Eye Camps and in addition have Urology teams from Royal Berkshire Hospital in Reading and Plastic surgery teams from AMREF to deal with cleft lip and palate problems.The Rehabilitation Unit supported by visiting colleagues from University College Dublin and CHEEERS have run camps for patients with cerebral palsy and a workshop on Stroke management which was attended by over 60 people including representatives from other church and government hospitals.

We are increasing the number of Medical Officers to strengthen our departments and this will give better continuity of care and cover. We are looking forward to the opening of our new Mental Health Unit in the next couple of months.

Community outreach clinics including mental health continue to be popular. We hope to increase the health promotion and screening side of this work and to run a community mental health and epilepsy outreach.

Our Child Sponsorship programmes continue to support orphans and needy families in our area with over 600 individuals benefitting.

Kisiizi Hospital Community Health Insurance Scheme

The Scheme continues to be popular and provides valuable support for a very poor community. We hope to expand the membership numbers in the coming year and to integrate health promotion and support in various ways. We are on track to break even again in this financial year. A ceiling on the total cover offered has been proposed. We have over 36,000 beneficiaries in 200 community groups in 4 districts anywhere as far as Lake Edward!

Patient Safety programmes

Kisiizi is one of only 5 African hospitals participating in the World Health Organization (WHO) / Johns Hopkins University Surgical Unit-based Safety Programme which is due to complete soon. Some of the findings from Kisiizi featured in the WHO website. We also continue with the WHO African Partnerships for Patient Safety scheme in liaison with Countess of Chester hospital in UK and are developing more health promotion materials for use in Kisiizi and the community. We also partner with WHO relating to Universal Health Coverage and hope our Stre@mline IT programme will help to implement some of the key principles identified in this work.

SUPPORT SERVICES

Stre@mline

Kisiizi was one of over 150 applicants to the Uganda National Council for Science and Technology NSTIP grants. Only six were awarded and our Stre@mline IT project was one of those chosen. We partner with Innovation Streams, a software development company in Mbarara. Stre@mline is an integrated patient-centred system incorporating patient safety features and providing very valuable audit tools. We anticipate Stre@mline will close some current gaps in our finance systems and improve efficiency in a number of ways. A number of other hospitals have already expressed interest and we will pilot in Kisiizi and in Rugarama Hospital in Kabale especially.

Laboratory

We have upgraded our lab extensively with much improved quality control and a greater range of tests for patients. The Stre@mline system will allow results to be accessed 24 hours a day from all over the hospital.

Pharmacy

We have reorganised the staffing structure and will upgrade the stores using the old staff room. Stre@mlineassists in accurate stock control and valuation and reduces the risk of stock-outs and drugs expiring on the shelf. Our main supplier is Joint Medical Stores who have reliable medicines and now have a depot in Mbarara.

Water supply

A filter unit has been successfully built to supply clean water to the wards and theatres. We are planning a pilot study of ozone treatment of water to our Guest House which may reduce the need for boiling water and save energy.

Estate

We continue to have dairy cows, a goat project, a chicken programme and a demonstration garden. These support the malnourished children and their families. We are harvesting eucalyptus trees and plan to let them regenerate though in the tourism park area will seek to plant more indigenous trees and bushes.

TRAINING

The regular weekly multi-disciplinary audit sessions and continuing professional development seminars are supplemented by extra sessions for interns and special focus workshops.

We had students on the Bachelors of Nursing degree course at Bishop Stuart University attached for practical experience over a 4 month period. This pilot went well and we will explore strengthening these links. We continue to have 3 similar students from Vives University in Belgium for a 3 month placement annually.

In November we will have a further group of doctors on a one-week placement as part of the London School of Hygiene & Tropical Medicine’s East Africa Diploma in Tropical Medicine course after the very good evaluations received following their first visit last year.

We continue to train 8 intern doctors and this year hope to start training two Intern Nurses for the first time. Medical students from Uganda and overseas have electives here and some come back as volunteers later.

We have run further training courses in Family Planning in conjunction with U-shape and aim to significantly increase the number of patients helped.

Kisiizi is sponsoring staff to train as specialists in General Medicine, Obstetrics & Gynaecology and in Imaging / Radiology, Midwifery and a Midwifery Tutor and the primary school is training a Special-Needs Education teacher.

LINKS / NETWORKS

Kisiizi is part of Uganda Protestant Medical Bureau and has contributed presentations to the annual symposium and articles for their newsletters. We have been able to network with other UPMB units in our region and quite a few teams from different institutions have visited Kisiizi e.g. Kiwoko, Kagando, Bwindi, RugaramaKabale etc.

Particular thanks go to Jamie’s Fund who are sponsoring the Mental Health Unit currently under construction. The regular support from Kisiizi Partners is vital for Kisiizi, and the faithful giving of Dorcas and Kisiizi Partners orphan programmes help large numbers of families in our area.

A World of Difference

We continue to thank God for the prayers and support of colleagues and friends within Uganda and across the world. It is amazing how wide a range of nationalities have visited, for example Cecilia Guridi, a travel photographer from Chile, came for a couple of months with her Irish husband who is a Consultant Psychiatrist. They live in New Zealand and she has now produced a book “A World of Difference: Portraits of Kisiizi” which is available on-line.

PRIMARY SCHOOL

We plan to build a new Boy’s Dormitory as the current provision is in poor condition. The following year we hope to establish a new Special-Needs classroom as we develop services for children with physical disability such as cerebral palsy.

KISIIZI FALLS TOURISM PARK

Remarkably, the Ministry of Tourism put Kisiizi forward as its only project from Uganda for the STEP (Sustainable-tourism, Elimination of Poverty) programme run by the United Nations World Tourism Organization. The South Korean government are the original donors. It will pump-prime development of our tourism facilities. Management are keen to ensure that the project enhances and in no way detracts from the natural beauty of the Falls and that there is no negative impact on the work of the hospital or the environment for Staff. We see tremendous opportunities to explain the Kisiizi story to many visitors and anticipate that some will be interested to offer some support. Profits from the park will go to the Good Samaritan Fund to help us keep our user fees as low as possible. We see this as an answer to prayers that the LORD would show new ways for Kisiizi to be more self-sufficient

FUTURE PLANS(see 5 year strategic plan from May 2015 on hospital website)

• Community Epilepsy / Mental Health programme

We have liaised with Basic Needs UK and Uganda and sister hospitals in Bwindi and Nyakibale to apply for support for a 3 year programme to improve the diagnosis, treatment and support of patients with epilepsy and with mental health problems.

• Expansion of Labour Ward and Special Care Baby Unit

The demand from mothers to deliver in Kisiizi continues to grow. The current facilities are cramped and may at times challenge safety for the care of both mothers and neonates. Management are therefore considering various options on how to re-organise our existing buildings with possible small extensions to improve this situation.

Longer term it may be appropriate to build a new block on the site of the current Ahumuza ward. This could include a larger maternity unit with operating theatres linked to our main theatre suite. This would improve the accessibility of anaesthetic and theatre staff.

• Expansion of Chapel

We have too little space for our current activities including Sunday services, outreach fellowships for patients and attendants and even daily staff prayers. We are proposing to re-orientate the chapel by including a section of the current surgical ward to the right of the chapel. This is the area that still needs refurbishing anyway and which needs roof repairs. We propose to extend the building to replace the beds lost by the chapel extension.

• Intensive Therapy Unit

The increasing complexity of surgery especially urology being undertaken in Kisiizi has caused us to care for greater numbers of elderly patients especially men requiring prostatectomies. They sometimes develop medical complications post-operatively and an Intensive Therapy Unit would give better support including ventilation when required. We have identified a plan to link the old theatre building to the new one to allow an ITU connected to our main theatres to be created which would facilitate prompt support from anaesthetists when needed.

• Imaging

As we develop services such as Orthopaedics we need better support such as mobile x-ray or Image intensifiers. Longer term the possibility of CT scanning is under consideration as it can greatly improve management of patients with head injuries or with signs of raised intra-cranial pressure etc. Currently patients have to go to Mbarara and pay 250,000UGX. If Kisiizi had such facilities we anticipate many patients would be referred from the region.

• Special Needs Children

One of the key themes in Kisiizi is “care for the vulnerable” and as we have a primary school, rehabilitation unit, paediatrics and psychiatry we have plans to provide some integrated services for special-needs children starting with those with physical disabilities e.g. cerebral palsy, Down syndrome etc. Later we may consider progressing to those with autistic spectrum disorders.

It seems remarkable that Kisiizi has had a number of extraordinary openings and opportunities:

• The oldest and probably largest community health insurance scheme in Uganda
• The only Ugandan hospital for a long time to provide in-patient mental health care in a rural setting
• The only hospital in Uganda in the first wave of the World Health Organization African Partnerships for Patient Safety
• One of only five hospitals in Africa chosen by World Health Organization for the Surgical Safety programme
• One of only 5 institutions worldwide to be chosen by World Health Organization to participate in the learning laboratory research on Universal Health Coverage and Patient Safety & Quality
• The only project in Uganda put forward by Ministry of Tourism to the United Nations World Tourism Organization STEP programme
• One of only six grantees for the NSTIP grants from Uganda Council of Science and Technology
• Provision of specialist clinical services such as upper-GI endoscopy, multi-disciplinary diabetic clinics with HbA1c testing, urological surgery etc. to a rural population.
• Provision of a very low cost Mothers Waiting Home to improve maternal safety

All the above raise Kisiizi’s profile positively and we hope help to share the Gospel near and far, even to the ends of the earth. We had a letter published in the Lancet medical journal recently relating to the role of faith-based organizations like Kisiizi caring for the poor.

We thank God for all He has done and will do in and through this remarkable place.

Thank you for your interest, prayers and support

“Life in all its fullness” John 10:10

STATISTICS HIGHLIGHTS (full data available with breakdown into sub-categories)

(forthe financial year: 1st July 2015 to June 30th 2016)

FINANCES

Church of Uganda Kisiizi Hospital is a not-for-profit NGO serving a very poor population. To facilitate access we established the very first community health insurance scheme in Uganda. We currently have over 36,000 beneficiaries in Rukungiri, Kabale, Ntungamo and Kanungu districts in 200 community groups up to 60km from Kisiizi.

Notes:Delegated = funds from Government of Uganda; Insurance =Kisiizi Hospital Insurance Scheme; Stre@mline = our IT programme; Cardno = organisation channelling HIV funds from USAID

• Patients only contribute 42% of our income (34 % from general patients and 8% from those in the insurance scheme).
• The contribution of the Government to Kisiizi’s income represents 4% of the total (“Delegated” sector in graph) plus 1% for Intern Doctor salaries. 95% of the income is from other sources.

The most recent Ministry of Health Annual Health Sector Performance Report (FY 14-15) records a Standard Unit of Output score of 174,112 for Kisiizi. This is greater than many other hospitals in our region and yet for reasons we fail to understand our government allocation of funds is less than these institutions with lower productivity. We are keen to see Performance-related-payments as we anticipate these would greatly boost our delegated fund allocation and keep our user fees as low as possible. As there is no government hospital in Rukungiri District, we and Nyakibale Hospital provide these services for our population. We work hard and our input has helped Rukungiri District come out well in the national tables.

CURRENT CHARGES TO PATIENTSNote: Kisiizi Hospital Insurance Scheme (KHIS) patients are only charged a co-payment of 2,000 UGX for an out-patient clinic consultation including standard tests and treatments or 20,000 UGX for an admission including standard tests, treatments, surgery etc. See separate information sheets.

NON-KHIS PATIENTSexamples of charges

Kisiizi Hospital never turns patients away and those in genuine financial difficulty may be helped by our Good Samaritan Fund. This fund also automatically covers the cost of milk for premature babies whose mothers have insufficient breast milk and it subsidises all mental health costs and insulin for diabetics.