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A Trip to Koome Island

December 23, 2011
Voices from the Field: Monica Millard, MUWRP Program Director

koome1.jpgDue to the good work being done by the Makerere University Walter Reed Project (MUWRP) PEPFAR program in Uganda's Kayunga district, a neighboring district, Koome subcounty, approached MUWRP about expanding its PEPFAR program into their district. In addition to the usual rural health care centers in this district, there are several fishing communities that also need HIV services. Although logistically challenging, MUWRP and district health staff are now providing Voluntary Counseling and Testing (VCT) and care and treatment on several islands.

Management was asked to visit Koome Island to better understand the working conditions of the MUWRP staff that travel to these islands to provide PEPFAR services. I was joined by Ali Taylor, the Lab Co-Director and Arthur Natwijuka, the Director of Administration & Finance.   

Koome subcounty is located in the waters of Lake Victoria and includes 16 islands and 30 villages with half of those villages located on distant islands. The resident population is estimated at 12,000 people and the number of non-residents is unknown. More than 90% of the population is fishermen, and transient, depending on the availability of fish—although it was noted that some are involved in the lumber trade. 

The harrowing journey begins

The boat departs at 7:00 a.m. so we decided to spend the night in Mukono, about an hours drive from Kampala. We departed at 3:30 p.m. from Kampala to avoid rush hour traffic, allow for unforeseeable delays and to arrive before dark, as traffic accidents in Uganda increase drastically after dark. We planned appropriately. About 45 minutes outside of Kampala the front tire fell off the truck we were riding in. We were traveling slowly and heard an unusual noise, but could not determine the cause. We were reminded of the frailty of life as most likely there would have been loss of life and injury to those in the truck and the people including young school children that walk along the roadside if we had been traveling at normal highway speed.  

The evening passed uneventfully and we departed Mukono at 6:15 a.m. for the Katosi landing site, where the MUWRP staff that had traveled from Kayunga were waiting. The life jackets, swim rings and rain jackets, in addition to the clinic supplies were already loaded in a local boat.    

koome2.jpgThe “boarding process” involves being carried onto the boat. Having no recollection of ever being carried in my adult or even adolescent life, I was very anxious, but followed the lead of the staff and allowed myself to be carried onto the boat. This method allows the staff to remain neat and clean for their clients who usually present in their Sunday best for their clinic visits. 

The lake is usually calm early in the morning so it’s important to get started early; however, about 40 minutes into the ride it started to rain. It made for some dramatic scenery with the contrast of the clouds and finally the rainbow as we arrive at Zingola Island. A few staff members and supplies for VCT testing are off loaded.  

The village leaders were expecting us, so we all unload (more carrying) and greet the leaders who express their gratitude for the services we are providing. All living quarters and even the school were temporary structures with no running water and only a few generators that provide power for refrigerators. Although there are women and children on the island, we are told that the women are shared among the fishermen as their wives do not stay on the island.   

Meeting a need

After the speeches the sun starts to shine, we prepare to re-board the boat for the 30-minute ride to Koome Island Health Center (HC) III. From the landing site we walk about 10 minutes to find about 100 people at the HC waiting for services.  

After a few speeches the staff begin to work, while we talk to some of the political and health leaders. They express concern about the lack of syringes and health staff, the cost of transport, the dangers of water travel and the loss of a full day wages to travel to the Kojja Health Center IV where they can receive antiretrovirals (ARVs). We explain our plan to upgrade this health center to become an accredited government site so ARVs can be provided here. They are happy for this news and think it will help with the adherence issues those currently on treatment face.  

koome3.jpgBy 2:30 p.m. everyone has been seen and had their blood drawn by the Clinical Officers. We head back to the landing site where several staff buy fish as everyone is hungry not having had a proper breakfast, tea and/or lunch.

We travel back to Zingola for the remaining staff and learn they have done HIV testing and counseling for about 50 people. We have an uneventful boat ride back arriving about 4:00 p.m. at the landing site, although now it is hot and everyone is tired and thirsty. All supplies (and people) must be unloaded and reloaded into the truck to travel to Kayunga District Hospital, where the blood samples must be delivered before the staff is finished for the day.  

Logistical challenges are plenty

As we are traveling back to Kampala, we learn that the CD4 machines are not working at either lab in the Kayunga district so we make a stop in Mukono to divide the samples so that some of the blood work will travel with us to Kampala and the remaining will go the Kayunga. We finally arrive back in Kampala around 6:00 p.m. with a greater understanding and appreciation for the work performed by the MUWRP PEPFAR staff. In addition to the long days, logistical challenges and weather changes, most Ugandans do not swim and fear the water so we must commend the staff on overcoming all of these obstacles to provide HIV prevention, care and treatment services to the fishing communities in Koome Islands.

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