Uganda

 

There are a large number of families affected by AIDS in Uganda, and in some areas it is estimated that about 20 - 25% of young children are orphans. They often live with a sick parent, or with a grandmother or aunt, who may be caring for several orphans. There is much poverty, and a carer often cannot leave the other children and take the sick child to the hospital. The distance may be too far and the trip too expensive.

 This scheme started in Kampala, where we offered care and support to 280 children who themselves had AIDS, and were also partly or wholly orphaned, usually by AIDS. The child and family were helped with food if necessary (through the World Food Programme). Each child was visited each month and given treatment to prevent and treat the infections which are common in people with AIDS, and were also given the antiretroviral drugs (ARVs) which can make such a difference to their lives. Much education, counselling and support was offered to the carers in many different ways, and sometimes we are able to helped with household items, like blankets and mosquito nets,  school fees (donated through an Italian charity), school uniforms and books.

 

An American organisation has now set up a programme for Kampala children who have AIDS. This will treat them with ARVs when necessary and follow them up to make sure they are using the treatment correctly. Although not offering the same kind of service as we did, we nevertheless felt that it was not appropriate to duplicate services in as needy a country as Uganda. We therefore handed over the care of the children to the new scheme, and transferred our expertise and our resources to a district called Kayunga, 70 km from Kapmala, where no other programme for children was in existence.

 

 

We successfully established a service of the care of children orphaned by AIDS within Kayunga district as the cornerstone of a comprehensive district AIDS programme that now incorporates community sensitisation about HIV, voluntary HIV testing, prevention of mother to child transmission of HIV (PMTCT) and care of infected and affected children

We started our Kayunga project early in 2005. There is much stigma attached to being HIV in this area. Our team spent much time in the villages dispelling the myths and beliefs about AIDS and its treatment, encouraging people to come forward for counselling and testing and to bring their children too. We had over 80 index children waiting to join the project.

 

Mulago Hospital, Kampala, has a very busy labour ward. A baby is born every 15 minutes or so, many of them problem births because of poor ante-natal care, prematurity, AIDS or other illness in the mother and other factors. The midwives have to care for the mother first before attending to the baby, and many babies here need some help in starting to breathe. Babies who do not breathe for several minutes after birth may be permanently mentally impaired or even die. Many babies needed to be transferred to the Special Care Baby Unit (SCBU), and many died.

 

In 2003, MCAI trained six midwives in the skills of neonatal resuscitation, and paid their salaries as extra staff on the labour ward solely for the purpose of attending to the newborn. Their presence on the ward greatly reduced the need to send babies to the SCBU and improved the rate of newborn deaths considerably.

The service has now been incorporated into the local health service strategy.

Babies and young children are often abandoned in and around Kampala and are brought to Mulago Hospital. Sometimes they are found in pit latrines or rubbish bins, or are left in the Acute Care Department. Sometimes the newly-delivered mother leaves the baby behind when she leaves the hospital. The reasons can only be guessed at: illness in the mother, too many children to care for, extreme poverty or early teenage pregnancy and lack of social support. There may be between 40– 80 children abandoned each year, and there may be 5 or more of them at any one time who need care and affection.

 

A child in a hospital like Mulago needs a caring adult to be there too. The adult must provide the child with sheets, clothes, nappies, a laundry service, food and drink and warmth and love. An abandoned child has none of these things.

 

Our Mothercare project employed a small team of ‘mothers’ who provided the support and care that a mother would provide, for the time that the child is in hospital. Sometimes the child is returned to the extended family, sometimes rehomed in a children’s home. Many of these abandoned children have some physical defect or obvious ill health. Many are HIV positive. Often these abandoned babies have to share a cot with one or two others.

 

MCAI decorated one of the children’s wards so that it is bright and ‘child-friendly’. The hospital let us have a small room off the ward to use as a play-room. This has also been brightly painted and stocked with toys, books and educational materials. Our project paid for the salary of a ‘play therapist’ who helped recovering children to relax and play, and helped older children in hospital for long periods, to continue their education.  The playroom is also used for the benefit of the abandoned children.