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'We are starting something here we are confident will have a very positive impact' Former Western Mail journalist Madeleine Brindley recently travelled to Uganda with South Wales-based organisation PONT to launch a PS250,000 project to set up primary healthcare and motorbike ambulance services in three regions - Gulu, Lowero and Tororo. Here, she outlines her experiences during the fortnight in the central African country.

ON OUR second day in Uganda we were told that a woman living in the northern district of Gulu had died from hunger. She committed suicide because she had nothing to eat.

This woman's death was not exceptional, we were told, in this part of the world, which was the heartland of the Lord's Resistance Army and where so many horrible things have happened over the past 20 years and continue to happen to a population exhausted by 20 years of war, kidnappings and terrible, pointless massacres.

But this is not a downtrodden population wallowing in the misery of the pastor the ongoing health and social challenges of the present. As we travelled north to Gulu from Mbale, bringing with us PONT's plan to work with local villages, local government and non-governmental organisations to set up primary healthcare and motorbike ambulance services and train health workers, we found communities committed to working together to improve their and their neighbours' lives.

In Bungatira sub-county, an area of seven parishes and 20 villages, we met a packed town hall of local chairmen, councillors, religious leaders and elders excited by the prospect of training to become community health promoters, health workers and motorbike ambulance drivers.

One of the village elders told us: "When I heard about this news I was very happy - it means our children will live to see another day.

"The challenge is now ours; we have accepted it and it is now up to us to go to our villages and make this dream come true."

Rose Amono Ambili, a district councillor in Bungatira sub-county, added: "This is the miracle we have been praying for. We have been experiencing war for 20 years and it has not been easy for our people to reach this point but now we have this project and we welcome it."

I joined a team of healthcare workers - GPs, midwives and paramedics - from PONT (a community-to-community link between Rhondda Cynon Taf and Mbale) and members of Gulu Mission Initiative, also based in South Wales, to travel to Gulu last month to set up a new project to improve access to primary healthcare.

The project replicates PONT's successful work in the Mbale, Manafwa and Bududa regions in south east Uganda, which now benefit from hundreds of trained health promoters and health workers. Communities also have access to motorbike ambulances to transfer injured patients and pregnant women to health centres for lifesaving treatment.

PONT was recently awarded a PS250,000 grant by the Tropical Health and Education Trust to partner three other Welsh charities working in Uganda - Gulu Mission Initiative, Care for Uganda and Vale 4 Africa - to extend the Mbale model to Gulu, Lowero and Tororo, respectively.

Over the next two-and-a-half years, 30 trained village health teams will be set up in each of these areas, supported by up to three motorbike ambulances. In total 360 community health promoters, 360 traditional birth referral attendants and 120 operational level health workers, who can diagnose patients and are responsible for calling for the motorbike ambulances, will be trained.

Martin Ojara Mapenduzi, Gulu's district chairman, whose surname means revolution in Swahili and who played a prominent role in attempts to end the LRA conflict by confronting its leader Joseph Kony, said: "We are starting something we are confident will have a very positive impact. There are lots of challenges here but this partnership will give very meaningful answers to questions we have been asking but haven't yet found answers to."

And James Ochan, a pastor in Gulu and a leading member of Gulu Mission Initiative, said: "Gulu underwent so many horrible things that this [the PONT project] will go a long way to improve the lives of many who are hurting."

Village health teams are central to the Ugandan government's policy to improve the health of the population. Official figures show there are 1,455 village health workers in Gulu, 82% of who have been trained, for a population of almost 400,000 people.

In reality, less than two-thirds of those are active, meaning there is one trained village health worker for every 860 people.

There are four hospitals - one state-run, one military, one run by a not-for-profit organisation and the other by a private company - and 66 health centres. The annual budget for each of the health centres is 26m Ugandan shillings a year - it sounds a lot but is equivalent to just PS6,300 at today's exchange rate.

There is a desperate shortage of doctors in the hospitals and there are few midwives working in the health centres - one of which, in Paminano, is closed, despite only being completed last year, because the government cannot afford to pay for medicines.

Although the government wants all women to give birth at their nearest health centre or hospital to reduce the number of women and babies dying, large numbers of women give birth at home because of the lack of transport, including ambulances, and the poor state of the roads.

The health centre in Bungatira recorded only 12 births between September and our visit at the end of November - the last birth was three weeks before our arrival. The nursing assistant at the health centre told us it was because transport is so difficult.

In the village of Rwotobilo, our minibus drove at breakneck speed along dirt and potholed roads to take a woman in labour to the health centre in Pabwo. She would have given birth to her third child at home because the only way she could have reached this health centre several miles away would have been to walk.

Maternal mortality remains a very real problem in Gulu and the rest of Uganda; 160 women died in childbirth in Bungatira sub-county last year.

Dr Paul Onek, Gulu's district director of health services, said: "We have very few midwives and the few we have can't be there all the time. The problem of Gulu is the problem of Uganda.

"We want to have at least two midwives in every level two health centre - we have 49 of these. But at the moment only half of these have a midwife and then only one. In the level four health centres we want four midwives but we only have two. We want staffing levels to be at 100% but even then 'normal' staffing levels are abnormal.

"We have trained nurses and nursing assistants to deliver babies.

It's very important for them to be able to identify the early signs of obstructed labour.

"If we can improve referrals from villages to health centres, that would be great - that means village health teams working with the community and with families to refer them. If a mother can reach a health centre when she's in labour where there's a qualified person that will be really great."

In every village where we explain the PONT project, which includes training traditional birth referral attendants to recognise problems in childbirth and refer women in labour to a health centre, it is met with applause because in every village women have died giving birth.

In every village, too, families have lost children. In Rwotobilo, the women told us they had lost two, three, four and even five children each - in childbirth or to disease before the age of five. HIV/Aids and malaria are the biggest killers. In Pabwo health centre, a handwritten chart records the most common health problems in adults and children - respiratory tract infections affect a staggering 71% of adults and 41% of children; malaria 25% and 22% respectively.

In addition to the high prevalence of disease, the people of Gulu are still coping with the legacy of the 20 years of conflict at the hands of Joseph Kony and his Lord's Resistance Army.

Many of the people we met during our trip to Gulu bear the very visible physical scars of that conflict and the terror and tortured meted out by Kony and his child soldiers.

"The war has caused us many problems," said Ojou Simon Opige, the level three chairman of Bungatira sub-county. "People have been murdered, maimed, widowed and raped. Many have been disabled and we also have to deal with the problems of HIV/Aids and many other diseases. But, if all goes well, we will get back to our normal lives before the war."

At the Bethel Christian School, run by Gulu Mission Initiative in Paminano, we met Samuel. He has a prominent scar which runs from ear to ear - the result of being cut with a razor blade by the LRA when he was younger.

This softly-spoken man cannot answer why he was attacked and scarred in this way; our questions bring fear and pain to his face.

In the village of Rwotobilo, the source of a large Ebola outbreak in 2000, all the men were kidnapped by the LRA to serve as child soldiers - there is a collective laugh of disbelief when we ask if any were involved in the war because they all were.

Some managed to escape in the bush; others were not so lucky; most served as child soldiers.

One man lifts his shirt to reveal the marks of torture on his back, another permanent reminder of the long years of conflict.

Even the landscape bears the scars of this long conflict, which saw an estimated 66,000 children forced to become child soldiers and sex slaves for the LRA and two million people across northern Uganda displaced - the last camps for internally displaced people closed just months ago.

The conflict is not over, it has only moved across the Ugandan border as Kony continues to evade international charges of war crimes and crimes against humanity.

Close to the Bethel Christian School and next to the newly-built but yet-to-open health centre in Paminano, there is a mango grove, offering welcome shelter from the heat of the equatorial sun.

It was here that villagers held their local market, setting out their stalls to sell the produce they grew on their small plots of land. Today all that remains of that market is a few faint impressions in the vibrant red earth.

One market day, during the war, the villagers made their way to the grove as normal. But on this terrible day, child soldiers had hidden in the trees. They climbed down and slaughtered everyone at the market with machetes and guns. There are knife marks and bullet holes in the trunks of the few trees which remain standing in the grove.

Steve Lock, a director of Gulu Mission Initiative, said the grove has been unnaturally and deathly quiet when he has visited in the past, with no sign of animal life.

He said: "It's as though everything avoids this piece of land because they know what happened here."

But the afternoon we visited - the sounds of music and dancing reaching us from the school in the distance - we could hear birdsong, echoing one elder's conviction that life will return to normal and Kony won't return. Evidence perhaps that Gulu is beginning to heal.

The camps have closed and families have returned to their native villages. Land is once again being ploughed, crops planted and produce harvested. But there is a distinct shortage of fruit and vegetables at the roadside stalls compared to the opulent displays elsewhere in Uganda and there is a missing generation in the villages and on the streets of Gulu town - the ultimate victims of Kony's relentless assault on his own Acholi people.

For more information about PONT visit www.pont-mbale.org.uk Madeleine Brindley is the former health editor at Media Wales and is now head of communications at Cwm Taf Health Board

CAPTION(S):

Part of the audience at meeting in Bungatira sub-county, Gulu

People meeting at Rwotobilo village, in Bungatira, Gulu, an area that is now covered by a Wales-supported ambulance service. The village was the source of an Ebola outbreak in 2000
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Title Annotation:Features
Publication:Western Mail (Cardiff, Wales)
Geographic Code:6UGAN
Date:Dec 31, 2012
Words:1986
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