Kiwoko Hospital
Made for Mission
At the very centre of Kiwoko Hospital, on which all other work is founded, exists and is maintained, is the practical outworking and the sharing of our faith in the Lord Jesus Christ. It is God who initiated and blessed the work there through Dr Ian Clarke and it is the same Father, God and Lord who enables, prospers and maintains the work there through His faithful people. So, in seeking to bring health and healing, Kiwoko also seeks to meet the spiritual needs of patients and to be a light to the people of Luweero and all those who pass through or are associated with Kiwoko.
Kiwoko Hospital Misson team
Kiwoko Hospital Mission team is interdenominational; it has over 40 members who are on the staff of the hospital. Its leader is Shadrach Lukwago and his story is as follows:
“This team has been in existence for 12 years. It was started by members who had a passion for the lost. The vision started with the aim of reaching out to the patients with the word of God. As this was initiated, we saw positive results. Patients were encouraged and were being encouraged to see some one praying with them beside their sick bed. As these patients were discharged they started to invite members of the mission team to their local churches. Even the local church leaders would send invitations to us. They would eagerly want to see the people who ministered to their people while in the hospital.
When we started visiting these churches, we felt the need for these village churches was to join them and do evangelism in their communities. We therefore started organizing missions in villages. We started getting
testimonies of lives of people and at the same time communities were being changed with the gospel. Since then we have continued to reach out to different villages with the gospel. We have also worked with different churches from different denominations to plant 30 new churches.
During our time of ministry in the villages we have discovered that the major need for these churches in the villages was the lack of trained church leaders. Most churches have leaders who have never had any theological training. Due to this problem, most churches in villages struggle a lot in many ways. This problem also affects us whenever we do a mission in a certain village, and many people give their lives to the lord, we always leave all the responsibility to the local churches to carry on with the discipleship programs with these new converts. However this has not been done effectively due to lack of adequately trained church leaders.
We have gone as far as initiating some programs to see that this problem is over come. For three years now we have conducted an annual Leadership Conference. The first conference had 175 delegates; the second had 275 delegates, the third conference which was conducted in Jan 2007, had 450 delegates attended the conference. This year in January 2008 we had over 600 delegates. The teachings which we have conducted during these conferences have been like tasters. Church leaders have benefited from them a lot. It is the reason why the number is growing each year.
We have also introduced the Christianity Explored course. We translated the guide book into the local language (Luganda). We have printed 2000 copies which have been used already in different villages. Two new churches
have started out of running this course in villages which never had any church before.
Having started these programs in our communities we have realized that most of the leaders are very hungry for training to enable them to become effective leaders in their churches. Therefore, on top of these programs we feel it is vital we start up a new program with the aim of training church leaders in ministry. To this end Kampala Evangelical School of Theology (KEST) have been approached through the office of the Academic Dean, Mr Peter Muriuki to determine if a partnership could be established that would allow KEST programmes to be run from the Kiwoko Hospital Training Centre. KEST have agreed to this link being established which will prove beneficial as we build appropriate courses for local pastors. KEST will bring experience, expertise and academic credibility to the whole process.
We are so grateful for Hamilton Road Presbyterian Church, Bangor Northern Ireland for the continued support which you have given to us and the interest you have to help and see that leaders are trained to help them become better ministers of the gospel”
Shadrach, Norah and Family.
History of recent developments in Leadership Training.
February 2005: The first church leader’s conference was held at kiwoko hospital youth Centre when 175 delegates attended.
February 2006: The second church leader’s conference was held when 275 delegates attended.
Christianity explored was introduced during this conference.
January 2007: The third church leader’s conference was held when 450 delegates attended.
Since its introduction last year 3000 people have attended Christianity Explored Courses and 2 new churches have been established as a result.
January 2008: The fourth church leader’s conference was held and more than 600 delegates attend.
During this conference the Kiwoko Bible Institute was launched and is expected to open later this year.
Pictures on pdf of 2008 conference - 2.8 MB Click here to download
It has been very encouraging to all those involved in Kiwoko to see God's Kingdom extending at the same time the hospital has been increasing in size and expertise. The two are directly related. To lose the worship, outreach and pastoral care would be to lose the very heart of the hospital..
Each morning, before the hospital starts back to work for the new day, there is a time of prayer and praise led by the staff. It is one of the highlights for anyone visiting. Pastoral care for patients, their spiritual, mental and physical needs, are met in Kiwoko. Please pray for the mission team, for its work inside and outside of the hospital.
A short history of Kiwoko Hospital
'It is not a mere preacher, that is wanted here. It is the practical Christian tutor, who can teach people how to become Christians, cure their diseases, construct dwellings, understand and exemplify agriculture and turn his hand to anything...'.(H M Stanley 1875)
Uganda : Geography, population, languages, economy and religion.
The total area of Uganda is 236,860 sq. km. (91,300 sq. ml). 25% of the area is arable land able to sustain several crops per year and capable of producing more food than the country needs (the breadbasket of Africa). The Victoria Nile which flows through the country and Lake Victoria make it one of the best watered areas in Africa. Lake Victoria is a rich source of fish but also, unfortunately, Bilharzia. The tropical heat is eased by the altitude - this averages over 1,000 metres. It is bounded in the north by Ethiopia and Sudan, in the east by its prosperous neighbour Kenya, in the south by Tanzania and Rwanda and in the west by Zaire. Its population in 1986 was estimated at 16 million people.
The official language is English with Luganda, the language of the Baganda, being the most widely used of the native languages. Lake Kyoga forms the northern boundary of the Bantu speaking people which includes the Baganda. The Lango and the Acholi live in the north - they speak Nilotic languages. The Teso and the Karamajong, who are related to the Masai, live in the east. Before Amin's time the country was nearly self-sufficient. There were thriving coffee, sugar and tourist industries along with some copper mining. The economy then went into rapid decline when Amin either expelled or killed all those with technical expertise. Under Obote there was a modest recovery in the production of cash crops.
The net result was that President Museveni's government inherited a ruined economy and infrastructure along with a large foreign debt. Nearly 12 million Ugandans have some church allegiance. There are 7.5 million Roman Catholics and 4.5 million Anglicans (Church of Uganda) with increasing numbers of Baptists and Pentecostalists. There is also a growing Muslim population of over 6%. President Museveni challenged the two main churches to lay behind past differences and set a lead for the nation both morally and in providing practical service. If you take the road north of Kampala and travel for forty miles you come to a town called Luwero. By then you will be in the Luwero Triangle which is now quite infamous. Between the years 1982 and 1986 there were over 250,000 people killed in the civil war between Milton Obote and Yoweri Museveni.
In Luwero if you go northwest on a deeply rutted dirt road for another half hour you will finally come to Kiwoko, deep in the Luwero triangle, 50 miles NNW from Kampala and one and a half hours drive from there. Kiwoko is an area which was very much affected in the war. Not only were the people killed but the buildings were destroyed. There were very few buildings which were left standing.
" It is truly incredible to be here, we are still finding it hard to imprint on our consciousness that we are actually in Uganda. The Ugandan people are really lovely, many of them will express appreciation of what you are trying to do." Dr Ian Clarke 2/8/1988
Ian and Roberta Clarke and family 1989 in Kiwoko.
Prior to 1988 Roberta and Ian Clarke were happily ensconced in the seaside town of Bangor with their family of three - Sean, Michael and Lauren . Ian was a General Practitioner in a local health centre. Then God spoke to them about going out to Africa. The opportunity came for Ian to visit the Luwero Triangle area of Uganda. God confirmed their call and before they knew it they were among the mud huts, bananas and elephant grass. The whole area was a scene of devastation following the civil war - almost all the buildings had been destroyed and only the local church, in which troops had been billeted, and their future home had been left ' intact'. Their home was the upper floor of a dilapidated farmhouse shared with several families of rodents!
"The need here is appalling. Everywhere you turn there is squalor, poverty, dirt and disease. The people are delighted to have a doctor, the response has been overwhelming." The Clarkes Feb./March 1988.
With a lot of effort and improvisation their home was made 'shipshape' with a small generator providing some light in the evening supplemented by solar lights later. The medical situation was easier to describe - there simply were no medical facilities in the surrounding area. Improvising again Dr. Clarke started to train some of the remaining local villagers in simple health care and hygiene, building up his first team of 18 Health Workers capable of treating diseases which were curable - such as Malaria . Immunization clinics against childhood diseases such as measles, polio, diptheria and tetanus were begun. Trips to neighbouring villages for treatment and immunizations were started and the people in the area rapidly learnt where to come for help. The situation in the area has been succinctly described in Julian Pettifer's book : 'Few areas of Uganda have a more tragic story to tell than the area of green and fertile farming land north of Kampala, known as the LUWEERO TRIANGLE. In the tragic war of retribution that bloodied the years of the Obote regime in Uganda, the area was systematically destroyed. In this grim climate, Ian Clarke, a Christian doctor from Northern Ireland, came to visit Luwero. He opened a clinic on the steps of a bullet riddled church. The floor of the church is his operating table, and in the doorway the local pastor, ironically named Livingstone, dispenses the drugs.' ( From the book 'Missionaries' by Julian Pettifer ).
The early days, Ian Clarke and Gudrun (a German nurse trained in Anaesthetics) at wotk in the dispensary, before the main hospital was built
In the first years came the hard slog of building up a team. Even for a Ugandan to move from the capital Kampala to the back of beyond in Luwero required the same type of sacrifice for a European to come to Luwero. Some people proved suitable, others not so suitable. By what seemed trial and error the team was built up. God moved the hearts of Europeans, Ugandans and North Americans to bring them to this area deep in the Luwero triangle. As the work progressed hand in hand initially with the Kasaana Orphanage project it became clear that the medical and orphanage sides should split into separate entities. The local people decided that they wanted to build a medical clinic. The medical team realised that there was a need for a Maternity Centre to care for expectant mothers and deal with difficult deliveries, a Laboratory so that they could improve diagnosis and somewhere to treat patients with Tuberculosis. Then in July 1988 through the unexpected death of Barbara Kelly in N. Ireland, monies came in to establish a memorial fund to build a Health Centre.
" Not one of us who knew her (Barbara) has gone untouched by her life. We have the privilege of seeing the fruit which her life and death have produced." The Clarkes 19/7/90.
Up to then they had only managed to build a dispensary, part of which had a family living in it. Hidden in the elephant grass the old foundations of a school were discovered and used to build upon. Bricks from ruined houses were used, caches of bricks were remembered and found in the jungle which quickly reclaims untilled land. The villagers eagerly made mud bricks, dried them in the sun and then fired them in earth kilns. Bricks of every shape and size were mortared and then plastered to help form the Barbara Kelly Memorial Hospital - it was twenty-four months in the building. All the work has of necessity been done on a shoe string. The vast majority of finance for the work has come from individuals and churches making small donations.
" It has been like the widow's barrel of flour - there is always just enough for the next meal or next step." The Clarkes 1989.
Many patients present with anaemia, sometimes due to Hookworm infestation in their gut, but more often due to malaria, especially in small children. For children and infants the situation can be life threatening making blood transfusion a necessity. However, before giving blood you need to make sure that you aren't going to give the patient AIDS through giving infected blood. Through cooperation with the central blood transfusion laboratory all blood is now screened by the most sensitive tests known except in dire emergencies when their own laboratory test is used - this is slightly less sensitive. The risks of giving the patient blood infected with the AIDS virus was reduced from over 20% to less than 1%. Karen Morgan, a bacteriologist from the West Coast C F in Vancouver, was been responsible for setting up the laboratory and training the technicians. The problem of the Acquired Immunodeficiency Syndrome (AIDS - called SLIM in Uganda for obvious reasons) caused by the Human Immunodeficiency Virus (HIV) cannot be underestimated. It is a problem which is not peculiar to Uganda which is trying to face up to it rather than hiding it. In large hospitals at least 60% of inpatients are HIV positive. Between 15% and 20% of the adult population are estimated to be HIV positive and either have or will go on to develop full-blown AIDS inside three years. Where possible those who suffer from HIV infection are counselled and prayed with. There is no cure for AIDS. There is much more to be done in the field of AIDS care, including health education, care of the dying and home care.
Previously the health centre was an offshoot clinic of Mengo Hospital in Kampala. It now has its own fully fledged Health Centre Board. Quarterly meetings of this board take place with day to day running in the medical superintendent's hands in association with the heads of departments. When Ian Clarke became ill and had to return to N. Ireland, Dr. Richard Montgomery took over the work and developed it further. Without his sacrifice and that of his wife Heather and family, the work in Kiwoko would have come to a dead stop, with the hospital slowly being taken over by the elephant grass, its shell being left to whisper of what had once been, of the faith and work and witness. Richard is now a General Practitioner in England.
Dr Donald Brownlie
Dr. Donald Brownlie, from N. Ireland, who took over from Richard, ably helped by his wife Una, retired from being medical superintendent only to take up a posting in his beloved Livinstonia in Malawi in 1999. Donald has worked in Africa most of his life, he and Una have given themselves exclusively and exhaustively to the work in Kiwoko, maintaining its fine 'Christian tradition' of service. This is the hallmark of Kiwoko Hospital - to give and give and give again. The poor are not turned away as in other places. Donald is now with the Lord, I have never met such a humble and dedicated man.
Dr Nick Wooding
Dr Nick Wooding, from England, was our previous medical superintendent and is now back in Oxford, England. He was greatly helped by David Hodgson. Dr Peter took over as Acting Medeical Superintendent. Dr Rory Wilson, from N. Ireland, is now the fifth ex-pat medical superintendent. Over the past couple of years Mr Jim McAnlis developed the new role of Programmes manager which Ken Finch has now taken over. Margaret McAnlis ran the student elective programme and income generation for HIV/AIDs patients; Judith Finch has taken over from Margaret, as well as fitting in her work as a therapist.
The days are long goen when a Medical Superintendent could do this job and also run the business/projects side of the hospital, apply for grants, supervise the farm etc.
Dr. Ian Clarke has written a book on his experiences in Kiwoko and Uganda and copies can still be had by contacting us. Dr Nick Woodings has written a follow-up book - on his time at Kiwoko.
Physiotherapy Department
Alison Fletcher. Kiwoko Hospital, PO Box 149, Luweero, Uganda. January 2003
Physiotherapy is an active department within Kiwoko Hospital. We are expanding rapidly, involved in clinical and training work, both in the hospital buildings and in the community.
What kind of patients do you see?
In the hospital, we work with anyone referred by a doctor. Our input extends from the general medical and surgical wards to maternity, NICU and paediatrics:
Fractures - many people are involved in road traffic accidents and sustain serious and/or complex fractures. An orthopaedic surgeon visits monthly to advise and operate, so we work closely with his team.
AIDS/HIV - there are so many clinical presentations of this devastating illness, and we treat what we find. Often patients have decreased mobility, and they may have complications such as peripheral neuropathy, TB, or meningitis. We would help them regain as much independence as possible.
Post-op - a general surgeon visits weekly and does elective and emergency surgery. We try to see all post-laparotomy patients to advise on their recovery. Emergency surgery during the week is done by our resident doctors in a newly built theatre suite.
Neurology - occasionally we see CVA patients, and those with head injuries, or meningitis. We only have moderate success with neuro patients as they are often discharged well in advance of reaching their functional potential.
Paediatrics - we see those on the general paeds ward with a variety of conditions - orthopaedic, neurological or respiratory. In addition, we have input to the Malnutrition Unit where we are working to promote physical development through play and activity. Occasionally we treat babies on the NICU with serious illnesses such as tetanus or meningitis. Both of these neonatal complications are uncommon in the Western world.
Outpatients - a variety of neurological and musculoskeletal conditions are seen here.
In addition to hospital programmes, we are working in the wider community as well. We join with the Community Based Healthcare team, in providing a community rehabilitation scheme. There is much disability in the local population, and we try to promote physical independence as much as possible.
Who do you train?
The physiotherapy assistants have been trained in-house, and there is the advantage of being able to continue this through our work with patients. Physio students from overseas have greatly benefited from their time here completing an elective placement.
We have an active role in educating other health professionals within Kiwoko as well, e.g.
Case reviews: physio intervention with complex patients for doctors
Manual handling training for students in the Nurse Training School
Neonatal positioning for nurses in the NICU
Post-Caesarean care + obstetric physiotherapy for midwives
Child development and play therapy for AIDS homecare team
Who works in the Physio Department?
1 British physiotherapist. Full time (Alison Fletcher).
1 Ugandan physiotherapist. Works 1 day/week on community programme
1 Ugandan physio assistant. Full time, trained on the job
1 Ugandan physio student. Sponsored by the hospital to train in Kampala
1 play volunteer. Works daily with kids on the Malnutrition Unit
What are your plans for the future?
Opening of larger and newly furnished physiotherapy department (planned early 2004) - with more space to treat patients.
Expansion and development of community programme - working at the interface between acute and community/long-term care to reduce chronic disability.
Ongoing development of training programmes for hospital and community staff, + physiotherapy team.
Klwoko Hospital, PO Box 149, Luweero, Uganda. 20 August 2004
Welcome to the new physiotherapy department! Amongst much chaos, we have, at long last, moved in...
Here is a little tour of the new unit:
In the jungle is a matted area, which will be used for treating small children -much better to have them on a mat than rolling off a table by accident. The jungle scene can be used for games too, and all around the walls are little ants drawn at different heights, which can be used for stretching exercises.
Our plinth arrived safely from the UK a couple of weeks ago, and will make a big difference, being height adjustable -but we had to make sure it had a hydraulic pump rather than electric, or if the bed was put as high as possible, a patient might get stuck there during a power cut! Beds on the wards tend to be fixed at an incorrect angle (i.e. broken) or sag in the middle, so this plinth will be of use to practice sitting, or getting up, or getting out of bed, with patients in those situations. It also helps when relearning balance if the bed is flat and not tilted 15 degrees!
One corner will be used for treating patients with hand or wrist problems: it is not much good trying to do exercises with your arm waving in mid-air, so we hope narrow tables will make that easier. We also have facility for making splints to immobilize. Of' protect damaged joints, although we can't necessarily get access to splinting materials easily.
Being Africa, we couldn't sit inside all day, so we have an outside area too. It is still to be totally completed, but the main bit is useable -it used to be a shelter for patient's attendants to cook under, but we have cleaned it up, and it can now be used for doing physio outside in a shaded and sheltered area. Some patients don't get outside much when they are on the wards, so this will give them a change of scenery, especially as we develop the garden area.
That's the treatment areas...but there's more! The store room ah, the storeroom. I was so excited when we put stuff in here, as our old office doubled as a store too -and the old office was smaller than the new storeroom. I just hope Moses and Emma manage to keep it tidy!
Then there's the office, which will mean two things: firstly, I will not have to do so much work at home, and secondly, while doing office work, I can be around patients, and on hand to sort out any queries or problems. This should improve the care and treatment our patients get, both in- and out- patients. The filing cabinet is a particular joy -I now have everything thoroughly organised (what a triumph to get it stuffed it in my car after buying it in Kampala, along with a thousand storage boxes, curtain wires, large paint cans, towels and other assorted essentials!).
There are so many directions this new department could take us in -as well as being a facility for treating individual patients, there is potential to use it for workshops, training sessions, staff aerobics classes (guaranteed hilarity), group treatment sessions, playtimes for those on the Nutrition Unit, centre for our monthly orthopaedic clinic, as well as space for us to expand the scope of rehabilitation at Kiwoko Hospital. I hope that we will have the services of an occupational therapist within the next year, which will add to and complement the physiotherapy service already established here.
Soon after moving in we had an open afternoon for staff to come and see the new place, with rehab-themed competitions as an incentive to attend. Staff from many different departments came, including the drivers, workshop, builders, administration and cleaners, alongside medical staff. Practicing wheeling a big wheelchair around helped them to understand the difficulties of being disabled and gaining access to buildings (the picture shows one of the builders negotiating the back door successfully), and looping beads onto a lace with one hand highlighted the problems faced every single day by patients who have lost the use of one hand or arm. 'Pin the tail on the zebra' was a particular hit, helping individuals to understand how perception of space is affected significantly by lack of sight. It was great fun to watch them having a go! We need to continue to work hard to make sure communication is excellent with the wards, particularly as we plan to remove patients from the wards for their physio treatment. I'll also spend the next few weeks working with Emmanuel and Moses, who is back on vacation at the moment, showing them how to use all this wonderful space!
Thank you for your contribution which has made all of this possible. Many people at the hospital have thanked me for fixing up the new department, but I alone could not have done it. Kiwoko Hospital exists through the generous donations and gifts of many, so thank you for your partnership, adding to Kiwoko's work and development in this way -may God bless you richly.
Love Alison.
Programmes of Care
Report on a visit to Kiwoko hospital to give you an idea of what goes on
Click here to open word doc.
Statistics
1. Population statistics for Uganda
2. Patient Care: 222 beds.
3. Staff: 359; 5 Doctors
4. Outreach activities: Health Education, Malaria control - treated bed nets, STI screening (sexually transmitted disease), Scripture Union, Counselling, HIV/AIDS home based care, Sanitation - latrine construction, Rehabilitation of disabled people.
5. Additional Community projects: Diptheria/tetanus/pertussis immunisation, BCG, Measles, School Health
6. Finance 2003-4
Patient fees 30%
Donors 60%
Ugandan Government 10%
Income 1550.0 UGSH million
Expenditure 1529.7
UGSH million
