Kaserem Medical Clinic by Charlie King

Friends

There is a phrase here in Uganda: “slowly by slowly.” We would say “little by little.” The term is appropriate for all most everything here. Change comes slowly, but it does come.

One area in which change is slow is the release from the clutches of dependency, a disease epidemic in Africa. Volumes are written on why this is, and I am not going there right now. The bottom line is that there is a noticeable tendency to wait for someone from outside—the local big man, some bureaucrat or functionary, the President, one’s pastor, perhaps a witch doctor, or some Muzungu (the all-purpose term for Westerners)—to fix things. So stuff tends to sit awhile, unfixed.

But don’t mistake me: the African culture, if I may be permitted a gross generalization, is in many respects one from which we could learn a great deal. Simplicity, patience, endurance, generosity, hospitality, humor, acceptance, and a sense that things don’t just happen by accident, are all characteristics that others have identified as part of the African world view, and which I see daily. And it’s one from which we could learn a great deal. Again, I could go on about that, but will spare you.

It is this sense of dependency, existing for whatever reason, that is so frustrating. In particular let me tell you about the Kaserem Christian Medical Clinic III in Kaserem, about 20km down the road from Kapachorwa. The clinic was built by TCWM, back when we were a mission of Trinity Church Central Oahu (TCCO), in 2002 (named in honor of Dr Michael Yancey, an Army MD who died on active duty), with a maternity ward built in 2005, (named in honor of Katherine Anderson, Pete’s mother).

For years TCCO, and later TCWM, supported the clinic directly. (In Africa, medicine is seen as a commodity. There is no socialized medicine. If you are sick, you pay up front, and get treated. But don’t fret, the cost is—not unsurprisingly—very little. Consequently, we made the reasonable assumption that the clinic could be self-supporting and African-run. There should be sufficient revenue between fees gathered, some limited support from the government and other local charities, to see the clinic through. So we slowly weaned the clinic off of direct support from us . . . . Our mistake was that we left the clinic governance in the hands of men who turned out to be thoughtless local leaders, and who looked at the clinic as their personal cash cow and property. In 2015, when we emancipated it, the clinic was stable and showed signs of growth. But by the summer of 2017 when I visited, the clinic was just about dead. The doors were open, but the clinic was seeing only about 30 people a month (and there is no other medical service within walking distance; the locals were seeking traditional remedies), and births down to one a month. Salaries were months in arrears, drug stocks were at zero balance, registrations had lapsed, and the place was filthy. It was a shock.

I wrote to some leaders of the Presbyterian Church of Uganda, as that denomination owns the clinic. And a small group of men came from Kampala to rescue the clinic. The leaders of the denomination fired the old governance body and installed a new one. They brought in a new “in-charge” a young man named Kiti Peter, who is a Clinical Officer (our equivalent of a PA). And Kiti Peter, through the force of his leadership and initiative, started turning things around (there is an MP4 clip of Kiti describing a difficult birth attached). Last May, the clinic was making a steady income, and had come close to balancing its books, so the local vultures came back in. In June I got a call from Kiti that he had been physically run out of the clinic, and the old crew was back in charge. Again, the leaders from Kampala came and restored order, reinstalling Kiti. And he continued to improve the clinic.

Today the clinic is clean, repainted, and busy. When I visited last Thursday there were people coming and going. Last month the clinic saw 400 outpatients, and delivered 31 babies, with another 5 sent to the district hospital due to complications. There was a waiting line for the well-baby clinic, and later for the expectant mother registration. The clinic has been promoted by the Ministry of Health from a category II to a cat III facility (which has to do with its allowed menu of services). The lab is testing for HIV, malaria, typhoid, STD, pregnancy, measles, blood, urine, and some other stuff that I forgot. The clinic is 7/24, never shutting its doors. Registrations are current, and other organizations are giving the clinic high marks—the District Health Officer rates it as the second best maternity clinic in the district (with the best being the government hospital), the Ugandan Protestant Medical Board provides a midwife, USAID enrolled the clinic in a voucher program for maternity services and a research program in HIV and pregnancy, and a national Christian youth group had a retreat at our Study Center and came and scrubbed the place top to bottom.

And the staff works, with remarkable calmness, under conditions that I find almost unbelievable. The water pump is broken and the clinic staff walks 500 m to a stream to fill jerry cans for everything they need. Their sterilizer is heated on a wood fire. The toilet is an outdoor privy. The only light comes from a few solar panels (the funds for electrification were stolen by a pastor, and that’s another story). The staff grows their own food. Kiti accepts patients on a promise to pay if they can’t do so at the time; he has never turned one away. They do neighborhood outreaches and education, going on foot for many a kilometer.

The staff has been caught up in pay, except for Kiti Peter who has gone without pay since last year when he took this charge on. He received a leave of absence from the government clinic at which he works, about 35 km away, and he committed to work until January 2019. He told me that if he could be paid, well and good, but if not, so be it.

What I saw last week was so remarkable that I can only thank the God in whose name the clinic was built. He has moved through many people to pull the clinic back from the brink of disaster. And the work was done by Ugandans, for Ugandans. While I regret the near collapse of the clinic, we had to let it go. Now we need to help it more indirectly.

And that is where I end this story – Kiti can only do so much. While he is getting the clinic on a stable basis for day to day work, the necessary improvements to the clinic (not to mention his pay) are beyond the means of the clinic to raise. For example, they need electrification – which is entirely possible as there is a National line about 500 m away –but that is thousands of dollars. They need a water system, and again, there is a National water line being laid down next to the clinic but the hook up, pipes, and plumbing are beyond the clinic’s means. They need a kitchen, a real toilet, bathing facilities, medical waste incinerator, a staff house, and a gate house. They need reasonable equipment (see the broken manual centrifuge in the photo of the lab, even the repair of that is beyond them). And it would be good to be able to pay Kiti.

TCWM is not a medical mission, as you know. We are a teaching and discipling organization. We do not own this clinic. But we built it, we have a responsibility for it, a love for it, and for its community. We want to help reward the initiative and independence shown by the recovery of this clinic, but we need help in doing so. I am not sure of the price tag for the items I mentioned above (I am working on getting a good figure), but it is in the neighborhood of $15000. If you know of anyone interested in helping this clinic, please let me know. This is not feeding dependency. It is rewarded integrity, independence, and hard work.

Cheers and blessings,
Charlie