The hospital bed occupancy was constantly over 100%- which means that health operators almost daily had to care for more people than each ward could accommodate. Unfortunately, the mortality data also confirm this dramatic scenario: mortality amongst children admitted to Pediatrics Ward was the highest registered in the past 14 years. In this dramatic scenario, the pediatric staff has always being operational, ready to welcome and assist all young patients, reserving constant attention and care for the most fragile.

For this reason, today we are even happier to inform you that, overcoming the great difficulties caused by the pandemic, we have managed to complete the renovation works of the Kalongo Pediatrics ward, continuing to guarantee continuity and quality of pediatric care.

A heartfelt thanks to Fondazione Mission Bambini Switzerland, Fondazione 13 Marzo, M&G for the important support and practical help of those who strongly believed in our project and supported it.

The new department already hosts many young patients with their families, in a renovated and child-friendly environment, to guarantee the best possible treatment and a safe and quality workplace for the staff dedicated to children.

THANK YOU SO MUCH to all those who helped us to make it happen![/vc_column_text][divider line_type="No Line" custom_height="50"][/vc_column][/vc_row][vc_row type="in_container" full_screen_row_position="middle" column_margin="default" column_direction="default" column_direction_tablet="default" column_direction_phone="default" scene_position="center" text_color="dark" text_align="left" row_border_radius="none" row_border_radius_applies="bg" overflow="visible" overlay_strength="0.3" gradient_direction="left_to_right" shape_divider_position="bottom" bg_image_animation="none"][vc_column column_padding="no-extra-padding" column_padding_tablet="inherit" column_padding_phone="inherit" column_padding_position="all" column_element_spacing="default" background_color_opacity="1" background_hover_color_opacity="1" column_shadow="none" column_border_radius="none" column_link_target="_self" column_position="default" gradient_direction="left_to_right" overlay_strength="0.3" width="1/1" tablet_width_inherit="default" tablet_text_alignment="default" phone_text_alignment="default" animation_type="default" bg_image_animation="none" border_type="simple" column_border_width="none" column_border_style="solid"][vc_gallery type="image_grid" images="10166,10162,10160,10158,10156,10151,10149,10147" image_grid_loading="default" layout="4" item_spacing="default" gallery_style="7" load_in_animation="none"][/vc_column][/vc_row]

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Nutrition persists as a very ancient problem in these areas, worsening at the end of the dry season when the reserves of the most recent harvest gradually run out. Thus the number of children - but also of adults - hospitalized for severe acute malnutrition increases, as well as the number of deaths.

In Uganda, every single medical exam has to be paid for in advance to avoid insolvency and if the patient can't afford the cost, they simply don’t do the exam. The advantage of the Ambrosoli Hospital over other Ugandan health facilities is that the costs of health services are reduced, thanks to the principle of charity, which is the basis of the mission.

Thanks to this, the patient is required to pay only a small fee for admission to the ward and for discharge, while access to drugs is guaranteed for the entire duration of hospitalization, regardless of the patient's financial resources. This may seem taken for granted in Europe, but in Uganda it is a milestone.

One of the main problems of Ugandan health care is the scarcity of health facilities, that can be even 10 kilometers away from the villages. The delay in the access to treatment is sometimes fatal. It can take several hours on foot to reach the hospital; a shorter time for those people who can afford a motorcycle ride – with "boda boda". The paradox of poverty is the staggering number of patients hospitalized with trauma to legs and feet (who regularly develop infection) caused by the tumultuous journey in boda boda on unpaved roads.

But despite the scarcity of means and resources, the tireless work of the medical and nursing staff of Kalongo Hospital guarantees daily assistance to hundreds of patients who are treated as well as possible. The plague of HIV, malaria and tuberculosis will certainly not be solved in this century. But the dedication and trust that the local population has in the mission make the fight against such conditions a priority commitment for each of us. 'To love and serve with joy' is the motto of the Midwifery School. Let’s try to make it our own, too ".

Elena Salvador, resident doctor in Infectious Diseases, Kalongo, April 2022[/vc_column_text][divider line_type="No Line" custom_height="50"][/vc_column][/vc_row][vc_row type="in_container" full_screen_row_position="middle" column_margin="default" column_direction="default" column_direction_tablet="default" column_direction_phone="default" scene_position="center" text_color="dark" text_align="left" row_border_radius="none" row_border_radius_applies="bg" overflow="visible" overlay_strength="0.3" gradient_direction="left_to_right" shape_divider_position="bottom" bg_image_animation="none"][vc_column column_padding="no-extra-padding" column_padding_tablet="inherit" column_padding_phone="inherit" column_padding_position="all" column_element_spacing="default" background_color_opacity="1" background_hover_color_opacity="1" column_shadow="none" column_border_radius="none" column_link_target="_self" column_position="default" gradient_direction="left_to_right" overlay_strength="0.3" width="1/1" tablet_width_inherit="default" tablet_text_alignment="default" phone_text_alignment="default" animation_type="default" bg_image_animation="none" border_type="simple" column_border_width="none" column_border_style="solid"][/vc_column][/vc_row]

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The decrease in antenatal visits is a consequence of the strict rules to prevent the spread of Covid-19, of the increased poverty that doesn't allow women to pay for the trip to the Hospital, and of the fear of infection. Such situation has caused a reduction of preventive therapies provided, with inevitable consequences on the health of the fetus and future mothers.

Such a high reduction in deliveries means an increase in unassisted deliveries, with consequent risks of maternal mortality, neonatal mortality, development of serious complications during delivery which can lead to permanent disabilities for both the mother and the unborn child.

However, in the midst of this difficult and disheartening moment, there are also many stories that thanks to the tenacity and resilience of the doctors and hospital staff, combined with the courage and strength of these mothers, reach a happy ending and make us look to the future with glimmers of positivity.

Like the story of Esther, a 19 years old young woman at her first pregnancy who came to the Kalongo hospital from the Komotor Health Center in Agago because she was in labor and with Covid symptoms. Arriving at Dr Ambrosoli Memorial Hospital, she was immediately tested for Covid and turned out positive. She was admitted to the isolation ward. A "special delivery

room" was created for her in the same ward, where she was constantly assisted by a midwife and the medical team who started treatment for Covid. Unfortunately, Esther's labor failed to progress for 2 days, probably due to high fever of the mother. The fetus started developing fetal distress.

The medical staff did not lose heart and promptly decided for an emergency caesarean section to save the lives of both the mother and the baby.

Everything went well, Esther and her baby recovered very well and they were discharged a few days ago from the hospital.

This is Kalongo, this is the strength of Dr. Ambrosoli Memorial Hospital who fights every day for the joy of life.[/vc_column_text][divider line_type="No Line" custom_height="50"][/vc_column][/vc_row][vc_row type="in_container" full_screen_row_position="middle" column_margin="default" column_direction="default" column_direction_tablet="default" column_direction_phone="default" scene_position="center" text_color="dark" text_align="left" row_border_radius="none" row_border_radius_applies="bg" overlay_strength="0.3" gradient_direction="left_to_right" shape_divider_position="bottom" bg_image_animation="none"][vc_column column_padding="no-extra-padding" column_padding_tablet="inherit" column_padding_phone="inherit" column_padding_position="all" column_element_spacing="default" background_color_opacity="1" background_hover_color_opacity="1" column_shadow="none" column_border_radius="none" column_link_target="_self" gradient_direction="left_to_right" overlay_strength="0.3" width="1/1" tablet_width_inherit="default" tablet_text_alignment="default" phone_text_alignment="default" bg_image_animation="none" border_type="simple" column_border_width="none" column_border_style="solid"][/vc_column][/vc_row]

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But this time things aren’t going well. After the birth of the child, the placenta is not expelled, Evelyn is losing a lot of blood, the young midwife struggles removing it manually. She finally succeeds but it is immediately clear that the patient needs blood. An ambulance picks Evelyn and her baby up and take them to Kalongo hospital. She arrives at the Out Patient Department unconscious, she has no blood pressure. The staff rushes to perform resuscitation maneuvers while the baby is sent to Neonatal Intensive Care Unit. Finally the patient regains consciousness, is stable, and is transferred to the ward. In the following days comes the diagnosis of malaria, which worsens her anaemia. However, Evelyn seems to go through all her misfortunes with an enviable strength.

Unfortunately after a few days in which she seemed to have recovered, Evelyn has high fever again, her stomach is swollen, she is coughing and has difficulty breathing. We think of a puerperal fever, probably induced by obstetric maneuvers. We start the antibiotics, but Evelyn is finding it harder and harder to breath. We have no doubt, we do the rapid test for Covid-19. To everyone’s dismay the test is positive.

They call me, it’s already Sunday evening, we cannot refer the patient to Gulu, where the isolation center is. We then arrange the transfer to our isolation area.

We prepare the oxygen, make some infusions. To our relief, her saturation seems to hold up well. We are optimistic.

But if her breathing maintains normal parameters, the abdominal situation doesn’t improve. Perhaps a surgery will be necessary. We explain that to the patient and her relatives, they are desperate. We contact Gulu again who inform us that they have no possibility of performing surgery, nor the suitable material to protect the ventilator.

I feel lonely, we all feel lonely. I think about our intensive care therapies, the beeps of the monitors resound in my head, I see again the team of doctors consulting.

I look around in the room where Evelyn is now asleep, the drip, the oxygen concentrator on standby, the pulse oximeter. I think about this young life that is facing such a great battle, against obstetric complications and against Covid. I say to myself “Come on Evelyn, we have to do this!”

Dr. Carmen Orlotti

Surgeon at Kalongo Hospital

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Like the pediatrician Tito Squillaci, the first Italian doctor that returned to hospital after the outbreak of the pandemic and who worked alongside Father Giuseppe in 1984.

 "This morning, speaking to the students, I indicated the date engraved on the entrance of the midwifery school, 1956. I told them that that year, so far away, had marked our life. All of us, from the various corners of Uganda and Europe, were there because a man with an eye to the future was concerned with preparing a crowd of women capable of working for women and for their most precious good: their children. . Father Giuseppe had realized Daniel Comboni's ideal, "Saving Africa with Africa", and understood that women are the real power of African society. All this is clear when observing the professional but also psychological path that the students start: disoriented and scared on arrival, prepared professionals and self-confident in the end, capable of taking over the fate of a mother and intervene with competence. Most of them come from rural areas, where women are still subject to strong conditioning, their studies therefore become a path of emancipation, and they become examples of change and progress for other women. 

Father Giuseppe, who knew well what it meant to give birth without even a midwife, during the civil war, although aware of the risks to his life, decided not to leave Uganda: he did it to save the school for midwives, to avoid the interruption of the training of  such an important figure, but also of a new civil conscience. And today the school is there ".

Tito Squillaci

Kalongo, March 2021

Today, more than ever, the school and the hospital need regular and constant support to be able to continuously carry on their training activities, which are essential to offer qualified assistance and care every day. Thanks to the people who are supporting us and continue to trust us![/vc_column_text][divider line_type="No Line" custom_height="50"][/vc_column][/vc_row][vc_row type="in_container" full_screen_row_position="middle" column_margin="default" column_direction="default" column_direction_tablet="default" column_direction_phone="default" scene_position="center" text_color="dark" text_align="left" row_border_radius="none" row_border_radius_applies="bg" overlay_strength="0.3" gradient_direction="left_to_right" shape_divider_position="bottom" bg_image_animation="none"][vc_column column_padding="no-extra-padding" column_padding_tablet="inherit" column_padding_phone="inherit" column_padding_position="all" column_element_spacing="default" background_color_opacity="1" background_hover_color_opacity="1" column_shadow="none" column_border_radius="none" column_link_target="_self" gradient_direction="left_to_right" overlay_strength="0.3" width="1/1" tablet_width_inherit="default" tablet_text_alignment="default" phone_text_alignment="default" bg_image_animation="none" border_type="simple" column_border_width="none" column_border_style="solid"][/vc_column][/vc_row]

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“To stop malnutrition it is necessary to reach and involve mothers, parents and local communities so that they learn how to recognize the first signs of malnutrition and become aware of the importance of eating nutritious food to prevent it. That is also why we visit the villages and teach people which foods to grow in their gardens and how to cook them to safeguard nutritional values. We promote good health and hygiene practices to prevent diseases such as worm infestations, diarrhoea and malaria that cause long-term malnutrition. Unfortunately, Kalongo District is very large and we did not manage to reach all the villages, there are still many families who cannot benefit from our nutritional and health advice, but we are not going to give up, we want to reach as many families as possible. There are still many children to protect and save ”.

We can't stop![/vc_column_text][divider line_type="No Line" custom_height="50"][/vc_column][/vc_row][vc_row type="in_container" full_screen_row_position="middle" column_margin="default" column_direction="default" column_direction_tablet="default" column_direction_phone="default" scene_position="center" text_color="dark" text_align="left" row_border_radius="none" row_border_radius_applies="bg" overlay_strength="0.3" gradient_direction="left_to_right" shape_divider_position="bottom" bg_image_animation="none"][vc_column column_padding="no-extra-padding" column_padding_tablet="inherit" column_padding_phone="inherit" column_padding_position="all" background_color_opacity="1" background_hover_color_opacity="1" column_shadow="none" column_border_radius="none" column_link_target="_self" gradient_direction="left_to_right" overlay_strength="0.3" width="1/1" tablet_width_inherit="default" tablet_text_alignment="default" phone_text_alignment="default" column_border_width="none" column_border_style="solid" bg_image_animation="none"][/vc_column][/vc_row]

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Ilaria Fumi, resident in neonatology and pediatrics[/vc_column_text][divider line_type="No Line" custom_height="50"][/vc_column][/vc_row][vc_row type="in_container" full_screen_row_position="middle" scene_position="center" text_color="dark" text_align="left" overlay_strength="0.3" shape_divider_position="bottom" bg_image_animation="none"][vc_column column_padding="no-extra-padding" column_padding_position="all" background_color_opacity="1" background_hover_color_opacity="1" column_link_target="_self" column_shadow="none" column_border_radius="none" width="1/1" tablet_width_inherit="default" tablet_text_alignment="default" phone_text_alignment="default" column_border_width="none" column_border_style="solid" bg_image_animation="none"][/vc_column][/vc_row]

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Medical and health staff in Kalongo is working hard on the emergency plan to deal with the epidemic with the support of the Foundation and the Italian doctors who have returned to Italy; the pediatrician Tito Squillaci is on the front line.

The main problems that the hospital has to face  are: on the one hand preventing the infection of the healthcare professionals considering the extremely limited availability of personal protective equipment; on the other hand avoiding the contagion among the patients, since carrying out swabs is almost impossible and there is a constant need to nurse patients suffering from pneumonia and breathing difficulties due to other diseases, especially in the pediatric ward. Guaranteeing oxygen supply becomes crucial, as the number of concentrators is not enough even under normal conditions.

There is no intensive care in Kalongo nor can it be set up because of the need of expensive and scarcely available equipment, but above all because of the lack of qualified staff.
The plan must be implemented with extreme urgency, as Dr. Tito Squillaci points out, without waiting for the first case to reach Kalongo. The virus can begin to spread in the community about 7-10 days before the first patient is detected. At the time of the first reliable diagnosis, the epidemic may already be out of control.
We should not forget that Dr. Ambrosoli Memorial Hospital is the only reference health center for an area populated by more than 500,000 people and where there is no other real treatment, a lifeline for the population of Agago district and the 6 neighboring districts.

Kalongo hospital has been identified as Hub Covid, the district reference centre for suspected cases and for the treatment of moderate cases, while the most serious ones should be referred to hospitals equipped with intensive care beds. Dr. Godfrey Smart, a surgeon and CEO of the hospital, is a part of the district task force for the Covid emergency.
The Ministry of Health has also established an outreach plan, which requires the hospital lab technician to carry out the swab at home. A decentralization plan is also being developed for the analysis of the evaluations, that are examined today by the Uganda Virus Research Institute of Kampala for which Kalongo hospital would become the district reference hub also for the analysis.

The alert is therefore very high, because differently from our hospitals that have the means, equipment and resources, although they are struggling, Kalongo hospital will have to fight the battle against Covid19 with bare hands and everything will be played on prevention.

The Foundation works making every effort to guarantee equipment, protective devices and medications to support the hospital and the local population; we are worried above all for those  people suffering from malnutrition and HIV, hepatitis, that have a very weak immune system and are more exposed to the risk of contracting the virus.
Any contribution is essential to avoid the spread of the pandemic in an area that has always lived in the daily emergency.
Do not leave them alone.

Testimony collected by Ilaria Fumi  pediatrics specialist of Idea Onlus

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I learned that you have to be strong because Strength is the first medicine to survive in such a rural context.

I learned that the climate change has affected the equator as well: the rainy season that should have ended in October doesn’t seem to stop, in fact it is a source of criticality.
I learned that humidity and rains cool down our premature babies who do not store energy and struggle to grow. There are no incubators for everyone, but fortunately the contact with their mothers, through the kangaroo mother care, allows the babies to store heat.

I learned that the concept of "essential" is relative: it is essential to have access to basic medical treatments but it doesn’t mean that they are available in every corner of the Earth.

I learned that time can have different meanings: with "hour" you can refer to minutes, hours, but also days. When a child has too low hemoglobin levels, it would be necessary to do something immediately, like a blood transfusion, but unfortunately here "immediately" depends on the availability of people (the same person cannot donate blood several times in close times), on their arrival from villages that sometimes are so far away, on the group compatibility; so unfortunately sometimes you can't help but adapt your concept of time to theirs.

I learned that a child's heart can beat with a frequency higher than 240 beats per minute for anemia, dehydration or sepsis and by providing transfusions, liquids and antibiotics it slows down its galloping rhythm giving the child the opportunity to smile again.

I learned that you need to think not once but many times before requesting an examination because here, even the most banal one (for example, the estimate of the hemoglobin value), has a cost that not everyone can afford.

I learned that it is fundamental to base one's medical reasoning on the medical record, on the signs through which a pathology appears, which in the western world are almost always connected with laboratory and instrumental examinations, but here they are very few and sometimes go "out of stock "

I learned that perhaps it is not a mistake to dismiss a child earlier than necessary because the mother admits that, once finished the food supplies, she would not know how to feed him.

I learned that anger at the awareness that more could be done but that "more" has not yet arrived here (and who knows if and when it will arrive) is a source of distraction and waste of energy. On the other hand, it is important to stay focused and direct our efforts to the many children who are still hospitalized.

I learned that solidarity is a value that everyone shows here, even the most distressed people, because it is important to feel everyone at the same level. There is no fight, there is no arrogance, there is no pretension for one's own children, not even for the most critical ones, because it is known that neighbors’ help comes in any case.

I learned that the word I hear the most is "Thank you". "Thank you because you have chosen to work here, Doctor" - "Thank you for the good work done today, Doctor" (repeated every day) - "Thank you Doctor for wanting to share your teachings with us".

But no verbal language couldn’t hold a candle to an exchange of glances, an exchange of smiles: the smile, in the language of patients in Kalongo, means a request for help, it means hospitality, it means respect, it means trust but it also means Thank you . In Acholi language: "Apwoyo".

Ilaria Fumi, resident in neonatology and paediatrics

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