“Kapujan is a very swampy area with high incidence of malaria, which is why it was chosen to be a sub-county of the Lutheran malaria program,” explains Atim Christie, the health worker in charge of the government-run Health Center III in Kapujan sub-county, in Katakwi, Uganda. (Photo: Atim Christie)
The Health Center III in Kapujan serves a catchment area of 14,241 people. Kapujan also has two local clinics, which are known as “Health Center II,” and 6 VHTs [Village Health Team members—volunteers who have received extra training from the Lutheran Malaria Program in Uganda]. Because the VHTs provide malaria-related health care and education at the household level, they are considered to be “Health Center I.”
Atim Christie describes the services offered by her health center: “The Health Center III offers both inpatient and outpatient services, lab and clinical services, HIV and chronic care services. When a VHT visits someone in their home and suspects that they have severe malaria, the case is referred to us. For malaria, we diagnose using both RDTs and microscopy. When someone presents with multiple conditions or severe complications (if they waited too long to get treatment, for example), then we refer those cases to a larger hospital. However, that is a minimal number of cases. Most cases can be treated here.
“We are grateful that all of our Health Center staff has been trained by the LWF program to treat simple and complicated cases of malaria. Now LWF is supporting us with staff training and by supplying Rapid Diagnostic Tests and ACTs [malaria medications].”
Collaboration with the VHTs
Atim Christie continues, “LWF has trained many Village Health Team members in this area and empowered them with skills to prevent and control malaria. They perform outreaches [open clinics] to test and treat at the local level. Every month they come to us to report out, to refresh their training. When a patient is very sick, the VHT will escort them to the clinic and will not leave until the patient receives treatment.
“We test everybody who comes to the clinic for malaria, just in case. If they are positive, we give the medicine. The VHT comes to bring water, to watch the patient take the first dose and to give advice for taking the rest of the medication.
“A challenge is when people do not finish their dose of malaria medication. Maybe they are trying to save some for later. This is getting better now because of VHTs and the sensitization they are doing in the communities. Now, the majority of people are doing it right. I attribute this success to the community outreach events and to the work of the VHTs. (Photo: a VHT (L) collaborates with a government health worker (R) at a malaria community outreach event.)
“In the past, the government gave out nets, just one per household. The problem was that the nets were not always used correctly. For example, sometimes they were used for fishing. Because of the message the VHTs are giving, we are making progress.
“Initially the number of inpatients increased slightly because of the work of the VHTs. There was increased awareness about malaria and an increased number of referrals. Then the number began to go down again because of the testing and treatment at the local level.”
Success: a reduction in malaria cases and malaria deaths
Atim Christie continues, “Before the program started, the prevalence of malaria in this community was too high. 75% of the cases at our clinic were due to malaria. We did not have enough Rapid Diagnostic Tests to test all of the sick patients, or enough drugs to treat all the malaria patients. We were overloaded.
“Before the project began we would have about 5 children dying each year in the Health Center from complications from malaria—mostly from anemia. Since the LWF program began, there has only been one child who died (the parents did not follow our instructions about treatment). And even the VHTs are not reporting deaths at the local level lately!
“The Lutheran program has boosted the morale of our staff. They are not always so busy with malaria cases now, and they have time to go and interact with the community and teach health-related skills. Now malaria cases represent only 50% of the cases we see here at the clinic. There is room for other patients now.”