Restoring hope for the Ugandan woman

Vesicovaginal fistula (VVF), commonly referred to as just ‘fistula’ is an abnormal hole extending between the bladder and the vagina that allows the continuous involuntary discharge of urine into the vaginal vault. It is as a result of long and obstructed labour and in most cases the babies don’t survive. MoH statistics indicate that there is an estimated 140,000 -200,000 women with this problem in Uganda, and only 13000 – 17000 women are able to receive medical attention.
Kizza is one of them. Just like the case with her last seven pregnancies she, walked into Nyenga hospital in Buikwe district to deliver her 8th baby. When she came out of theatre her bladder was leaking and she could not hold her urine. She thought it was normal and would stop on its own, but the condition got worse. In no time, it had become part of her. This was the beginning of a long walk of shame that she has had to endure for the last three years.
The 54 year old says her husband left her because she smelt. ‘I cannot describe the humiliation and scorn that I have endured. My husband left me and even my family members see me as a disgrace. I cannot go to public places and I don’t remember the last time I was at a family gathering. I pray that by the time I leave CoRSU I am completely well.’ Kizza narrates.

She is one of the 14 women who were mobilised in areas of Wakiso and Kalangala Island to receive reconstructive surgery during the week long camp held at CoRSU hospital, from 2nd – 5th February 2015.
According to Dr Judith Stenkamp, the brain behind the camp, Fistula is most common in first mothers but can also occur among women who have already had children. The most vulnerable people however are teenagers. “The head of the baby can be stuck too long in the pelvis, pushing against the bones and compressing the bladder; and the longer it takes also against the rectum, causing a rectal vaginal fistula, resulting into loss of stool,” Dr Stenkamp explains.
She notes that isolation, the stigma around the condition, ignorance, poverty and illiteracy also lead to many going untreated.  Other causes of obstetric fistula are early marriages, sexual abuse, rape, trauma surgeries.

One of the women who underwent surgery

One of the women who underwent surgery

How is VVF treated?
Dr Stenkamp says VVF can only be treated through surgery. “When fistula is still small and fresh, it can be managed by catheterisation – a medical procedure used to drain and collect urine from the bladder.”  She adds that it would be possible to detect VVF in its early stages if only women sought proper medical care and delivered in hospitals.
On top of receiving post-operative care, the patients currently at CoRSU received information about Fistula, its causes and how to prevent it. This was done to demystify some of the myths they had about the condition and hopefully boost their self-esteem. Dr Judith worked alongside Dr Andrew Browning, an Australian obstetrician and gynaecologist who has worked in Ethiopia and Tanzania as a senior fistula surgeon.
On why she organised the camp, the enthusiastic gynaecologist says “It is very rewarding nice work. I am happy the surgeries went well but all will be clear when we have removed catheters.”
This camp was sponsored by Fistula foundation, a non-profit organisation that raises awareness for prevention and treatment of obstetric fistula, whereas mobilisation was done by CoRSU CBR, Wakiso and Kalangala district officials and Terrewode, an organisation that mobilises and reintegrates patients with fistula after therapy.


3D printing of prosthetic limbs begins at CoRSU

A team of 10 members from Canada are at CoRSU Hospital from January 19-23, setting up three 3D printers, training local orthopaedic technicians, and test fitting young patients with new 3D-printed prosthetic sockets.

The goal is to equip CoRSU’s orthopaedic workshop to deliver better-fitting prosthetic legs to children who need them – faster and at less cost.

The International Monetary Fund estimates that there are a quarter million children with disabilities in Uganda.

“Many children have lost limbs due to severe bone infections, polio, injury and violent conflict. Others have been born with defects or malformations. Thousands of these children are going without the prostheses they need, because there aren’t enough orthopaedic technicians to make and fit the prostheses,” reports Mitch Wilkie, Director of International Programs for cbm Canada, and leader of the project team. “The result is children who are unable to walk to school, or run and play with their friends. These kids live with greatly limited opportunity and too often with stigma and discrimination.”

“The World Health Organization (WHO) has indicated that the current shortfall of prosthetic technicians in the developing world is 40,000 and that they can only train up about another 18,000 if they spent another 50 years doing so,” according to Matt Ratto, professor at the faculty of information at the University of Toronto, who is a member of the team at CoRSU this week.

In order to solve this problem, cbm Canada is partnering with University of Toronto and Ratto’s team, using consumer-grade 3D printing and scanning technology to reduce the need for technicians in developing countries, by making it easier to make parts for prosthetic limbs.

The entire process requires approximately 6 hours and less than $12,000 in equipment; the cornstarch-based PLA plastic to make a socket costs about $3.

Currently in Uganda, producing a socket involves 5 to 6 labour-intensive days and the use of plaster of Paris moulds dried in the sun, causing often ill-fitting sockets, the discomfort of which discourages their use.

The project team will experiment with a variety of plastic materials and techniques for printing the wall of the socket for greatest strength and durability with the least weight and material. They will also evaluate the potential use of Canadian custom-made 3D printers that may be better purposed for this application in the developing world.

Most importantly, the team will incorporate good development principles by ensuring disability inclusion, gender equity and environmental sustainability within the project’s scope.

cbm is a leading international Christian development organization committed to improving the quality of life of persons with disabilities in the poorest countries of the world. The organization helps more than 24 million people annually, supporting over 600 life-changing projects (like CoRSU), serving those with disabilities in more than 70 developing countries.

For more information, see,

Neurosurgical camp begins at CoRSU

Rotary Club of Muyenga Breeze members pose for a photo with Hon Dr Elioda Tumwesigye (C) and the CoRSU CEO Malcolm Simpson (in a white shirt) with other CoRSU staff members

Rotary Club of Muyenga Breeze members pose for a photo with Hon Dr Elioda Tumwesigye (C) and the CoRSU CEO Malcolm Simpson (in a white shirt) with other CoRSU staff members

Hon Dr Elioda Tumwesigye, Minister of State for Health in charge of General Duties this morning officiated the opening ceremony of the week long Neurosurgical camp that is taking place at CoRSU Hospital till 4th December. The most common conditions that will be treated are defects of the spinal code and the brain. According to Rotary Club of Kampala Muyenga Breeze, the organisers of the camp, screening for patients started in October. 30 people were identified and are to benefit from free surgery. This has been made possible because of different individuals, most notably Dr John Christie from Australia and Dr Joel Kiryabwire of Mulago who will be the main surgeons.

From left, Dr Bwire, the Rotary of Kampala Muyenga Breeze president, Hon Elioda, Christine - Principal therapist and Dr Sarah - Mediacl Director of CoRSU showing the minister around the hospital. In the background, Dr Christie

From left, Dr Bwire, the Rotary of Kampala Muyenga Breeze president, Hon Elioda, Christine – Principal therapist and Dr Sarah – Mediacl Director of CoRSU showing the minister around the hospital. In the background, Dr Christie

Hon Elioda thanked the doctors for dedicating their time for free to give Ugandans such a service, CoRSU for restoring hope where there is despair and the Breezers for organising the camp. He said as a ministry, they cannot do much with the current budgetary allocations that afford 33000UGX per Ugandan, but is also curtailed by overhead costs.
The Rotary Club of Kampala Muyenga Breeze is made up of about 40 members and has been in existence for one and a half years. But young as they are, they are already making a difference in people’s lives.

Pepelio, one of the patients who benefiting from the camp by receiving free surgery being examined by Dr Sarah and Dr Christie just before his surgery

Pepelio, one of the patients benefiting from the camp being examined by Dr Sarah and Dr Christie just before his surgery

World Sight Day

World Sight Day (WSD) is an annual day of awareness held on the second Thursday of October, to focus global attention on blindness and vision impairment. World Sight Day 2014 is today 9 October 2014.
This year, the ‘Call to Action’ for World Sight Day is:
No more Avoidable Blindness
Let us work together to:
•    Raise public awareness of blindness & vision impairment as major international public health issues
•    Influence Governments/Ministers of Health to participate in and designate funds for national blindness prevention programmes
•    Educate target audiences about blindness prevention,  about VISION 2020 and to generate support for VISION 2020 programme activities
International Key Messages
•    Approximately 285 million people worldwide live with low vision and blindness
•    Of these, 39 million people are blind and 246 million have moderate or severe visual impairment
•    90% of blind people live in low-income countries
•    Yet 80% of visual impairment is avoidable – i.e. readily treatable and/or preventable
•    Restorations of sight, and blindness prevention strategies are among the most cost-effective interventions in health care
•    The number of people blind from infectious causes has greatly reduced in the past 20 years
•    An estimated 19 million children are visually impaired
•    About 65 % of all people who are visually impaired are aged 50 and older, while this age group comprises only 20% of the world’s population
•    Increasing elderly populations in many countries mean that more people will be at risk of age-related visual impairment.

Giveability Newsletter

We are delighted to once again share with you our #GIVEABILITY Newsletter. In this issue we highlight the negative impact of a condition that affects physical appearance, prevents normal social activity and how it can be avoided and treated. #Keloids are a common problem yet children from poor families cannot afford treatment. Such disfiguring conditions can affect patients beyond the physical state and cause deep psychological scars. With your #donations we can offer subsidised #operations for children like Gertrude and help them live a normal life. Enjoy!

Andrea Bossari

It is not unusual to host volunteers at CoRSU, but this was the first time we had a Psychotherapist visit the hospital. Before he left we had a chat with him about his work and visit.

Tell us your name and what you do

My name is Andrea Bossari. I am a psychologist and psychotherapist. A psychologist is an expert researcher about the mind and it takes five years to study at the university. A psychotherapist is a person who treats people and tries to alleviate their discomfort. Studying psychotherapy takes four more years.

Where did you study to be a psychologist and psychotherapist?
I studied all this in Italy. But I also love culture, and that is one of the reasons why I came here. I also studied abroad. I spent one year in Japan on an exchange program when I was doing my master’s degree, then I spent summer to prepare my master thesis in Thailand, Asia in a monastery. I spent there three weeks with monks, living almost like them, following part of the rules to study meditation because eastern philosophies already 2500 years ago had incredible knowledge of the mind. They used a lot of practices to alter the mind, like meditation. So I was curious to study more to understand more the mind. And indeed meditation currently is, since like ten years ago becoming more and more popular in the west as a way of treatment because it’s very effective. It’s called mindful approach treatment.
I also studied languages. I have been in Brazil to study Portuguese, in Colombia to study Spanish and there I developed my second passion-anthropology. That was one of the reasons that pushed me to come here. When I heard of the proposal to be a visiting psychologist on volunteer basis to this centre in Uganda, I accepted with a lot of enthusiasm and joy because it was a chance to discover Africa, learn a new culture, and learn the psychological differences. It’s a matter called cross-cultural psychology. It was a pleasure.

So, do you speak Spanish and Portuguese?
Yes, they are very close to Italian so it was easy for me. (Andrea mummers some words in Spanish, Portuguese and Italian. The interviewer cannot quite tell the difference. That’s how close those three languages are.)

How do you find Uganda so far?

It is great. I am very happy. My friends told me Africa is so easy, and I didn’t have to worry. Indeed, I have found it easy since I arrived from the airport. There is in the end something relaxing. That is how I find Uganda. For example, being white is not a problem at all. It’s also something fun and nice being a mzungu. Here everybody is smiling warmly and children when they see a mzungu, they always wave and smile. I feel comfortable with the people, weather and landscape.

Let’s narrow it down to CoRSU. What do you think about this hospital? Did you know the kind of work we do before this visit?
Massimo, the CEO of CBM Italy described for me a little bit about CoRSU but of course I did not know anything. So I was very surprised by the excellence of the centre. I work with Christine (Principal Physiotherapist at CoRSU); she is a very good worker, very keen. She pushed me to work so hard. But it was very good because I explored every field in CoRSU. I also went to the villages with CBR (Community Based Rehabilitation) field workers. The standards here are very high and I think one year from now it will become big and bigger because the people here are working very hard.

What was your intention of coming here?
I came here because CBM wanted to try to put some psychological assistance to people with disabilities with problems. So they are trying to see how to offer psychological services. But I accepted also because of personal reasons- for personal growth to get a chance to discover the culture here and discover Africa.

Have you achieved what you came to do?
Yes, definitely. I am very satisfied. The tough part was being confined in my guest house but I feel satisfied. It’s great, and moreover everybody welcomed me. Uganda is beautiful, calm and relaxed. I went to Jinja, the Nile and the weather is like spring back in Italy.

Did you find a difference in the way you practice psychotherapy in Italy and here in Uganda?
No. But there are differences between culture and of course language. Language was the main big obstacle but in the end this is great because we are really human beings. The core is the same so there was no much difference, the main concepts of feelings and emotions are all the same. But of course I had to work in a different way. For example I had to work one session for each patient, yet psychotherapy takes a lot of time, many sessions.
All the patients I worked with apart from one could not speak English. It was difficult but I had to use all the power of the subconscious and I felt very happy because I felt I improved a lot. The situation here was extreme but I had nothing to lose so I did all I could, gave all I had, followed my deep subconscious and it really worked. That surprised me. All the patients said thank you to me in a touching way. I gave them something nice, so I am very happy.

Andrea in the community with Agnes, one of the CoRSU CBR workers

Andrea in the community with Agnes, one of the CoRSU CBR workers and a patient

What are some of the challenges you experienced working here?
Language, like I earlier mentioned. I had to use a translator and that slowed everything down.
Time was also a challenge because I had only one session per person. Of course you cannot treat someone fully in that time but you can give them some seeds. You can really help them to make some changes. You can break some defense mechanisms, so even one hour could be very useful.

How long does it usually take for you to treat someone fully?
It’s very personal. Everybody is different. It’s different from medical diseases. In psychotherapy, everybody is unique. But on average, it takes between 6 months to one year to treat common diseases like anxiety disorders and panic attacks.

Do you think CoRSU needs a full time psychologist?
Yes, it would be great. It would be important to hire a psychologist who speaks the language and can communicate with all the patients. I consider it every fundamental. Children with such disabilities are broken in their bodies but also in the emotion – mind. Their schoolmates treat them badly to the extent that they feel different from others. They do not express emotions, either of joy or anger. So once you repair the body, you of course change their life but they are also scared in their emotion and soul. So there is really need to help them, to teach them to connect to their emotion again.

What is the most memorable moment for you?
• They are many, all related to patients. The most recent one was with the CBR staff, Sylvia. We visited a village with a malnourished child. I also felt a sentiment of admiration for William (Community mobiliser) who was helping a patient to build a standing frame.
• The other was with the patients I had. One boy came with a bandage due to a fracture of the arm. He was the only one who could speak English. He was so happy because with him I spent more time.
• Another moment was playing with children at the rehabilitation centre. My favorite is a girl who has no arms and legs but they are making her artificial legs to help her walk.

Anything else you want to say?
I hope to come back. I will ask CBM to send me back to Africa. Say thank you to everybody.

Andrea at a school in a Kampala suburb to see one of the pupils who received surgery thanks to help from CBM Italy

Andrea at a school in a Kampala suburb to see one of the pupils who received surgery thanks to help from CBM Italy

CoRSU holds first Information health session on the benefits of Arthroscopy

One of the images used to illustrate how an arthroscopic procedure can be done

CoRSU held its first ever Health Information Session on Arthroscopy services on 3rd September, at Hotel Africana. The session was tailored for staff of health clubs, sports associations and health facilities.

The aim for convening this session was to raise awareness on available diagnosis and treatment of joint injuries using #Arthroscopy . Arthroscopy is a minimally invasive procedure on a joint in which an examination and sometimes treatment is performed using an arthroscope inserted in the joint through a small incision.

Who needs Arthroscopy?

Patients with joint problems such as pain, tumors, frayed or loose bodies and infections in the joints.  These illnesses are commonly found among athletes and the elderly. According to Dr Robert Ayella, some of the main areas that can be diagnosed and treated with #Arthroscopy are: Knees, shoulders, hips, ankle joints, wrists and the spine.

The keynote presentation on arthroscopy was delivered by Dr Moses Muhumuza, one of the six Orthopaedic surgeons at CoRSU. He elaborated on which parts of the body arthroscopic diagnosis and treatment can be performed.

He also explained the advantages that arthroscopic treatment has over conventional open surgery. These include; minimal soft tissue dissection, small capsular incisions, decreased postoperative pain, decreased stiffness, early return to function and few complications.

A team of our in-house and visiting surgeons have so far successfully performed more than 25 arthroscopic surgeries. Compared to the costs of getting the procedure abroad, the charge of treatment is relatively cheaper in Uganda.