Bwera and Fort Portal Hospital Emergency Care Education - Uganda
Bwera and Fort Portal are in western Uganda, a region that is experiencing a colossal influx of asylum seekers fleeing inter-communal violence in the Democratic Republic of Congo. On 1 August 2018, the Democratic Republic of Congo (DRC) declared an Ebola Virus Disease (EVD) outbreak in North Kivu Province, close to the DRC-Uganda border. As of 25th September 2018, a total of 151 cases of EVD had been reported to WHO by DRC.
The epicentre of the current outbreak is close to Uganda’s border to the West. Natives from both countries cross to engage in business, attend school, access health care and social services. With 22 at-risk districts identified, MoH and partners have implemented Ebola preparedness and readiness activities to prevent the disease from crossing into Uganda, and to ensure early detection of the disease should it be imported.
Border entry screening at all major border points in all the very high-risk districts has been implemented using volunteers trained by the WHO and Red Cross. With infrared thermometers, everyone crossing into Uganda from DRC is screened for body temperature. The people found with high temperature are further screened for Ebola-like symptoms.
Bwera General Hospital, a public hospital funded by the Uganda Ministry of Health, sits in one of the high-risk areas. It serves the surrounding sub-counties in the Kasese District as well as patients from neighbouring Democratic Republic of Congo. It is the only government-owned hospital in Kasese District and although its official bed capacity is 100, it often admits up to 300 patients. Like most government hospitals in the country, Bwera faces many challenges including non-functioning equipment, under-staffing, poor funding, over-worked staff and slow payment of staff.
Fort Portal Hospital (FPGRH), with a capacity of just 300 beds, is one of the 13 Regional Referral Hospitals in Uganda and sits just 130 km north of Bwera. In the event of an Ebola outbreak in the region FPGRH will undoubtedly be crucial to the response.
Our aim was to provide doctors and nurses with medical courses to cover both medical and trauma emergencies, but in this case a focus on the prevention of infectious disease transmission was essential. We delivered the courses to a multi-disciplinary group with every clinical grade represented, from medical assistants to consultant level physicians – and in terms of developing teamwork, this approach worked exceptionally well. Allowing clinical teams to learn in there own environment, while performing in their standard role and with the genuinely expected level of support available, provided a great opportunity for each grade to understand the scope of practice of other grades. It also ensured that clinical leadership roles could be explored in real time and under precisely realistic conditions.
The Bwera and FPGRH staff performed admirably in difficult conditions, but this perhaps is no surprise, its what they do every day – it’s become a way of life for these clinicians to improvise, adapt and to develop novel approaches with limited resources to high risk, complex problems, and always under the spectre that the worst may be yet to come.
Enabel and The 625 have a common understanding that courses alone are not enough and that turning lessons into sustainable practice is key. Moving forwards, Enabel are investing in a coaching and mentorship program that involves not just practical training but also online support, the generation of clinical guidelines, procedures and protocols and an online repository for clinical training resources. This is genuine sustainable development and we are incredibly pleased to have been contracted to provide this additional level of support.
Our teams love working in Uganda and we enjoy a brilliant relationship with Enabel. We are lucky to do what we do, and every day we are blown away by the capability, commitment and fortitude of the clinicians we meet. It’s a privilege.