Nsambya Home Care
Encyclopedia
Nsambya Home Care is one of the departments of Nsambya Hospital
Nsambya Hospital
St. Francis Hospital Nsambya, commonly known as Nsambya Hospital, is a hospital in Kampala, Uganda's capital and largest city.-Location:...

, a faith based
Faith-based
The term faith-based is a neologism , mostly current in US English, to describe any organization or government idea or plan based on religious beliefs, specifically Christian beliefs....

 hospital in Uganda
Uganda
Uganda , officially the Republic of Uganda, is a landlocked country in East Africa. Uganda is also known as the "Pearl of Africa". It is bordered on the east by Kenya, on the north by South Sudan, on the west by the Democratic Republic of the Congo, on the southwest by Rwanda, and on the south by...

. The department offers medical and psychosocial support to people living with HIV/AIDS (PLWHAs). During 2003, 21% (309/1435) PLWHAs were registered as having tuberculosis
Tuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...

 (TB). These patients were followed up for treatment outcomes. A total of 126 patients were expected to complete treatment by the end of 2003. The treatment default rates were 56%, 50% and approximately 80% among the new, relapse and former defaulter TB patients, respectively. NHC, established in 1987 by Sr. Miriam Duggan, is a department of St. Francis Hospital Nsambya
Nsambya Hospital
St. Francis Hospital Nsambya, commonly known as Nsambya Hospital, is a hospital in Kampala, Uganda's capital and largest city.-Location:...

. Since then NHC has been providing care and treatment services to over 15,000 clients cumulatively (to-date). With support from the AIDS
AIDS
Acquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the human immunodeficiency virus...

 Relief program and in collaboration with Catholic Relief Services
Catholic Relief Services
Catholic Relief Services is the international humanitarian agency of the Catholic community in the United States. Founded in 1943 by the U.S. bishops, the agency provides assistance to 130 million people in more than 90 countries and territories in Africa, Asia, Latin America, the Middle East and...

 (CRS), the program started providing ARVs in 2004 and so far close to 2000 active patients are benefiting from treatment. It is headquartered in Nsambya
Nsambya
-Location:Nsambya is located approximately south-southeast of the central business district of Kampala, along the road to Ggaba, a suburb of the city. The coordinates of Nsambya Hill are: 00 17 57N, 32 35 17E.-Landmarks:The landmarks on Nsambya Hill include:...

, a section of Kampala
Kampala
Kampala is the largest city and capital of Uganda. The city is divided into five boroughs that oversee local planning: Kampala Central Division, Kawempe Division, Makindye Division, Nakawa Division and Lubaga Division. The city is coterminous with Kampala District.-History: of Buganda, had chosen...

, Uganda. A field office of the program is located at Ggaba
Ggaba
-Location:Ggaba is located on the northern shores of Lake Victoria, at the southern tip of the city of Kampala. It is bordered by Murchison Bay in Lake Victoria to the south and east, the village of Kawuku to the northeast, Bbunga to the north, Buziga to the northwest and Munyonyo to the southwest....

, a southern suburb of Kampala. NHC has approximately fifty (50) employees, as of December 2007. The Organisation is led by Dr Maria Nannyonga Musoke a consultant paediatrician of Nsambya Hospital
Nsambya Hospital
St. Francis Hospital Nsambya, commonly known as Nsambya Hospital, is a hospital in Kampala, Uganda's capital and largest city.-Location:...

.

History

Nsambya Home Care was initially founded and managed by the Franciscan Sisters
Franciscan Sisters
Franciscan Sisters can refer to:* Franciscan Sisters of Christian Charity* Franciscan Sisters of the Eucharist* Franciscan Sisters of Mary* Franciscan Sisters of Perpetual Adoration* Franciscan Sisters of the Sacred Heart...

, as a response to the AIDS scourge in 1987. There was overcrowding in the Nsambya Hospital
Nsambya Hospital
St. Francis Hospital Nsambya, commonly known as Nsambya Hospital, is a hospital in Kampala, Uganda's capital and largest city.-Location:...

 wards; hence the opening of a separate department for AIDS patients. Rooms were eventually put up for counselling to ensure confidentiality. The very weak clients who were not getting better were visited in their homes by a doctor, a nurse and a counsellor.

In 1987 a total number of 327 clients were registered. The numbers increased as years went by. Different interventions were put in place to respond to challenges that cropped up. These included the creation of outreach clinics, Behavior Change Programs, Paediatric Counselling, Income Generating Activities, Youth Forum for the youth, Pastoral care
Pastoral care
Pastoral care is the ministry of care and counseling provided by pastors, chaplains and other religious leaders to members of their church or congregation, or to persons of all faiths and none within institutional settings. This can range anywhere from home visitation to formal counseling provided...

 services, Education for life programs, AIDS sensitization programs and involvement of client volunteers in the program.

Aids patient Care in areas of high sero-prevalence is becoming a problem, with increasing demand on hospital bed capacity. Various innovative approaches have been tried to provide care, but cost analysis against benefits of these approaches has rarely been done. Nsambya Hospital
Nsambya Hospital
St. Francis Hospital Nsambya, commonly known as Nsambya Hospital, is a hospital in Kampala, Uganda's capital and largest city.-Location:...

 used inpatient, outpatient and outreach mobile Home Care for AIDS to provide a continuum of care since 1989. Hospital records of AIDS patients cared for and the corresponding costs were analyzed for a rough cost benefit evaluation of this approach.

Chronic illness is a common but very much neglected health problem in sub Saharan Africa. People suffer from longstanding pain and symptoms caused by ‘incurable’ conditions like cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...

, heart disease
Heart disease
Heart disease, cardiac disease or cardiopathy is an umbrella term for a variety of diseases affecting the heart. , it is the leading cause of death in the United States, England, Canada and Wales, accounting for 25.4% of the total deaths in the United States.-Types:-Coronary heart disease:Coronary...

, diabetes, COPD
Chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease , also known as chronic obstructive lung disease , chronic obstructive airway disease , chronic airflow limitation and chronic obstructive respiratory disease , is the co-occurrence of chronic bronchitis and emphysema, a pair of commonly co-existing diseases...

 and kidney failure
Renal failure
Renal failure or kidney failure describes a medical condition in which the kidneys fail to adequately filter toxins and waste products from the blood...

. In the last decade, the numerous AIDS patients have joined this group. Their main and common problem is a longstanding, progressively debilitating condition, which silently undermines their physical and mental health
Mental health
Mental health describes either a level of cognitive or emotional well-being or an absence of a mental disorder. From perspectives of the discipline of positive psychology or holism mental health may include an individual's ability to enjoy life and procure a balance between life activities and...

 and weakens their socio-economic status
Social status
In sociology or anthropology, social status is the honor or prestige attached to one's position in society . It may also refer to a rank or position that one holds in a group, for example son or daughter, playmate, pupil, etc....

.

To date Nsambya Home Care has more than 10,000 active clients involving children. This paper will discuss the interventions put up by a religious based organization in fighting, and caring for AIDS patients without blaming or condemning them.

Activities

Nsambya Home Care offers services like;
  • HIV test
    HIV test
    HIV tests are used to detect the presence of the human immunodeficiency virus , the virus that causes acquired immunodeficiency syndrome , in serum, saliva, or urine. Such tests may detect antibodies, antigens, or RNA.- Terminology :...

    ing and CD4
    CD4
    CD4 is a glycoprotein expressed on the surface of T helper cells, monocytes, macrophages, and dendritic cells. It was discovered in the late 1970s and was originally known as leu-3 and T4 before being named CD4 in 1984...

     count
  • Antiretroviral drug
    Antiretroviral drug
    Antiretroviral drugs are medications for the treatment of infection by retroviruses, primarily HIV. When several such drugs, typically three or four, are taken in combination, the approach is known as Highly Active Antiretroviral Therapy, or HAART...

    s and treatment of opportunistic infection
    Opportunistic infection
    An opportunistic infection is an infection caused by pathogens, particularly opportunistic pathogens—those that take advantage of certain situations—such as bacterial, viral, fungal or protozoan infections that usually do not cause disease in a healthy host, one with a healthy immune system...

    s
  • Outreach programmes to patients and to schools and communities
  • After care services to patients and provision of necessities like food every week.
  • Behavioral change programmes especially in schools
  • Training volunteers and councellors to take care of patients
  • Controlling stigmatization:


Children sick with HIV/AIDS are ostracized by family members, communities, schools and playmates who fear contracting the disease. They are denied play, stopped from going to school, used by own parents to ascertain own sero-status. Those who opt to take them up demand for blood check ups against the children's will. Children are always told lies about the kind of check up, counselling for Pre-test is always given to care-givers and not the real children, the sero-status is always discussed and known by relatives or care-givers and medical workers but not the children themselves.

The whole situation of counselling and testing children defy the issue of making an "informed decision" for the HIV test and the professional ethics regarding confidentiality. The patient's own consent on whatever is to be done on him or her is broken since the child's care-giver handles the counselling and caring that involves the child. The children's own stories about their feeling and problems they meet regarding HIV/AIDS are tested and counselling shared. The importance of disclosure to the child, confidentiality and information sharing concerning the child's sero-status are analyzed.

"Nsambya Home Care informs people about the spread of HIV/AIDS. Dr. Maria Nannyonga said that AIDS
AIDS
Acquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the human immunodeficiency virus...

 is spread mainly through having unprotected sex with an infected person. Secondly, she said the HIV virus
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...

 is spread through blood transfusion
Blood transfusion
Blood transfusion is the process of receiving blood products into one's circulation intravenously. Transfusions are used in a variety of medical conditions to replace lost components of the blood...

. This still a big problem because some of the blood donated could contain the AIDS virus, but because it is still in its early stages (the window period), the blood still tests negative and then transfused into a patient.

The virus can also be transmitted from mother to child. This can be before, during or after childbirth. The virus can only be transmitted to an unborn child if there is a damage to the placenta otherwise an infected mother can give birth to a healthy baby. A baby on the other hand can get infected through breast feeding. The infected mother is thus expected to only bottle feed the baby since the breast milk contains HIV. AIDS can also be further spread through un-sterilized instruments like needles, razors, knives. This mainly affects traditionalists who are exposed to such objects especially during circumcision.

There is a general belief that one can be infected during the act of deep kissing. However, according to the doctor at the center, this is only possible if the uninfected person has a sore in the mouth or if that person swallows twenty liters of saliva of the infected person. Normal kissing usually does not carry those risks.

NHC teaches about the signs and symptoms of HIV/AIDS. There are major and minor symptoms. It also teaches about various ways of reducing the transmission of the HIV infection. Dr Erika Vlieghe a physician who previously worked at NHC writes *

"Monday morning, a rural district hospital in Uganda. A ward round through Female Ward. A 40-year-old woman has been brought in with diabetic coma
Diabetic coma
Diabetic coma is a reversible form of coma found in people with diabetes mellitus. It is a medical emergency.Three different types of diabetic coma are identified:#Severe diabetic hypoglycemia...

. She is actually recovering while receiving insulin, but how to continue the treatment at the village? Two women in their fifties are recovering from another exacerbation of cardiac failure
Congestive heart failure
Heart failure often called congestive heart failure is generally defined as the inability of the heart to supply sufficient blood flow to meet the needs of the body. Heart failure can cause a number of symptoms including shortness of breath, leg swelling, and exercise intolerance. The condition...

. For one, it is already her third admission since last summer. They complain of painful ascites and their failure to perform the household tasks. In the same room, three women aged between 25 and 45 are admitted with extensive and very painful breast tumours. They are very embarrassed about the deformities and the smell. The nearest place offering specialist care for cancer patients and radiotherapy is 400 kilometres (248.5 mi) away, through a war-ridden area.

In the next bed, an emaciated old lady has hardly been eating or drinking for the last 6 weeks because of an oesophageal tumour. In the afternoon, a 45-year-old women is found to have a locally spread tumour of the cervix. She thinks she cannot afford to go for radiotherapy, although the smelling vaginal discharge and the pain are really disturbing her. A young man is very uncomfortable with his legs swollen and knobbly because of Kaposi's sarcoma
Kaposi's sarcoma
Kaposi's sarcoma is a tumor caused by Human herpesvirus 8 , also known as Kaposi's sarcoma-associated herpesvirus . It was originally described by Moritz Kaposi , a Hungarian dermatologist practicing at the University of Vienna in 1872. It became more widely known as one of the AIDS defining...

. He does not know he has AIDS
AIDS
Acquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the human immunodeficiency virus...

. He hopes he can go back to the kraal soon. In the evening, an old man arrives from a place 100 kilometres (62.1 mi) away because of a painful hard swelling in his upper abdomen: a gross liver tumour
Liver cancer
Liver tumors or hepatic tumors are tumors or growths on or in the liver . Several distinct types of tumors can develop in the liver because the liver is made up of various cell types. These growths can be benign or malignant...

.

Unfortunately, the needs of those chronically ill are not met by far in most existing health care services. If the illness has a treatable or stabilisable cause (e.g. diabetes, or some types and stages of cancer), often the treatment is not available, not maintained for a long period or not given in an adequate way. Thereby, little or no attention is given to the broader needs in chronic illness: follow-up, counselling, information and education, involvement of the relatives, social or material support, rehabilitation. It seems that in general, chronic illness does not fit in most of the existing services, as they are designed for acute and communicable diseases
Infectious disease
Infectious diseases, also known as communicable diseases, contagious diseases or transmissible diseases comprise clinically evident illness resulting from the infection, presence and growth of pathogenic biological agents in an individual host organism...

 and for standardisable, short episode illnesses. In most programs and reports on health needs in sub Saharan Africa, chronic illness is not given adequate attention or the priority it deserves. There are several reasons for this lack of priority. Some are true, and difficult to resolve, but many arguments originate from misconceptions, myths and a reluctance to face changing health patterns in developing countries."

Funding

Nsambya Home Care is funded by a number of organisations like Catholic Relief Services
Catholic Relief Services
Catholic Relief Services is the international humanitarian agency of the Catholic community in the United States. Founded in 1943 by the U.S. bishops, the agency provides assistance to 130 million people in more than 90 countries and territories in Africa, Asia, Latin America, the Middle East and...

 and CAFOD
CAFOD
The Catholic Agency For Overseas Development, previously known as the Catholic Fund for Overseas Development, is a United Kingdom-based international aid agency working to alleviate poverty and suffering in developing. It is funded by the Catholic community in England and Wales, the UK government...

. However, with the completion of the new building project, there is still a shortage of funds to care for the ever increasing number of patients. This is the list of funded programmes in the country by CAFOD, ActionAid
ActionAid
ActionAid was founded in 1972 as a child sponsorship charity when 88 UK supporters sponsored 88 children in India and Kenya, the focus primarily being to provide children with an education. Global accounts are now reported in Euros and in 2007 and 2008 turnover was close to 180m Euros...

, Christian Aid
Christian Aid
Christian Aid is the official relief and development agency of 40 British and Irish churches and works to support sustainable development, alleviate poverty, support civil society and provide disaster relief in South America, the Caribbean, the Middle East, Africa and Asia...

, ICCO and Oxfam
Oxfam
Oxfam is an international confederation of 15 organizations working in 98 countries worldwide to find lasting solutions to poverty and related injustice around the world. In all Oxfam’s actions, the ultimate goal is to enable people to exercise their rights and manage their own lives...

.
  • Kiyinda Mityana Diocese Social Services Department - Sponsored by CAFOD
  • NUDIPU - Sponsored by CAFOD
  • Nsambya AIDS Home Care – Sponsored by CAFOD
  • Ugandan Joint Christian Council (UJCC) – Sponsored by ICCO
  • Grassland Foundation – Sponsored by ActionAid
  • Kumi AIDS Support Organisation (KASO) – Sponsored by ActionAid
  • Uganda Women’s Concern Ministry (UWCM) – Sponsored by ActionAid
  • Integrated Development Activities (IDAC) – Sponsored by ActionAid
  • Nsambya Home Care – Sponsored by CAFOD
  • ACET – Sponsored by Christian Aid
  • Mission Moving Mountains (MMM) – Sponsored by Oxfam
  • KADP – Sponsored by CAFOD

Future and development

On December 4, 2007, Nsambya Home Care celebrated twenty (20) years of hard work and dedicated service to communities affected by the HIV
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...

 pandemic
Pandemic
A pandemic is an epidemic of infectious disease that is spreading through human populations across a large region; for instance multiple continents, or even worldwide. A widespread endemic disease that is stable in terms of how many people are getting sick from it is not a pandemic...

. Celebrations to mark NHC's 20th anniversary coincided with the official opening of the new building complex just opposite Nsambya Hospital main gate and this was the venue for the day. The Guest of Honour was be His Eminence Cardinal Emmanuel Wamala and he laid the foundation stone.

External links

The source of this article is wikipedia, the free encyclopedia.  The text of this article is licensed under the GFDL.
 
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