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Generous spirit of Welsh mothers and children in volunteers saving lives of poverty-stricken Uganda; It's been almost 10 years since the PONT team made the first of 700 visits to Mbale and has raised almost pounds 1m to support the link's work. As the team prepares to return to Uganda in November, Madeleine Brindley from Cwm Taf Health Board looks at some of the improvements to healthcare.

* HE Ethiopian famine was a watershed moment in the relationship between the affluent Western world and Africa.

As popstar - now Sir - Bob Geldof mobilised a nation to raise millions to help provide immediate food relief and aid, the famine would prove to be the catalyst in redefining the way we support African nations, not simply during crises and disasters.

Among the hundreds of British clinicians who flew to the aid of the tens of thousands of starving refugees on the drought-stricken plains of Ethiopia in 1984 was a young paediatric senior house officer based at the former East Glamorgan Hospital.

Geoff Lloyd's experiences in the refugee camp would not only shape his own career but they were the inspiration for the established PONT link between Rhondda Cynon Taf and Mbale, in Uganda.

"We were working in the refugee camps - the need was so huge and it was so dreadful that many of us thought we have to commit the rest of our lives to this," Dr Lloyd said.

"It totally transformed my thinking - I had been intending to work overseas as a British doctor but during the famine, I was the only white person in a camp of 10,000 refugees. I realised then that the only thing I could do was to be a resource to them; to help them do the job they were already doing.

"That was a transformation moment for me - that the most effective way to deliver healthcare in other countries was to empower the people there to do it."

PONT, a community-to-community link between Rhondda Cynon Taf and Mbale, in Uganda, was officially set up in 2005 as a response to the creation of the Millennium Development Goals and the turn-of-the-century movement to make poverty history.

There are currently 13 different partnership links, ranging from healthcare to education, churches and the environment, making PONT unique among the growing number of projects in the UK - it is widely regarded as a leading example.

Dr Lloyd said: "The idea of PONT is to be a bridge between Wales and Uganda. Rather than going to Africa and saying we're the experts and we'll tell you what to do to deliver healthcare, we've entered into a partnership with health professionals in Uganda.

"With regular visits from our teams, we ask what they want and how we can help them to provide healthcare better."

The healthcare side of the programme has three main elements - developing primary care, ambulance and hospital services in Mbale. It is the only link of its kind, which works across multiple health sectors.

To date, PONT has trained more than 500 community health promoters who give advice about general health and nutrition in their local villages of some 700 people - these 500 cover a population of about a third of a million people in total.

Around 100 of the best of these community health promoters have been given additional training and equipment to become operational level healthcare workers. They work in villages and are able to diagnose illnesses, give out medicines and refer the sickest to hospital.

Dr Cath Taylor, a GP who leads PONT's primary care team said: "The primary healthcare team has also been working with traditional birth attendants in Mbale - women who attend births in their villages. Many have now been taught how to do that safely and also to identify any problems, such as obstructed labour, which may warrant referral to hospital." But such training will be in vain if the sickest people and women with complex problems during pregnancy are unable to make the long journey to hospital, often over unfriendly terrain. One of the biggest successes of PONT to date has been to create an ambulance service in Mbale from scratch, which has already saved countless lives.

Gio Riva, an advanced emergency practitioner at Prince Charles Hospital, in Merthyr and a member of PONT's ambulance group, said: "There were stories of people coming to the district hospital and dying needlessly because it had taken too long to get there because there was no transport.

"A pregnant woman with a half delivered baby arrived at hospital on the back of a push bike; within hours the baby was dead and the mum didn't survive - it was harrowing." Mbale is now served by a number of eRanger motorbike ambulances - the first two were introduced in December 2010, following fundraising by Welsh Ambulance Service staff. Ashby de la Zouch Rotary funded a third and a grant from the Global Poverty Action Fund will provide another six over the course of three years. Meanwhile the Rotary Club in the Midlands has pledged to fund a further 30.

PONT engineers and the ambulance team have developed bicycle stretchers, which are made in the Mbale workshop and can be used to access hard-to-reach casualties and there are also 180 mountain rescue stretchers - called Al-mobiles after their inventor from the University of Glamorgan - in use in the region.

Mr Riva said:"These ambulances are being used 24/7 - we supply the operational level healthcare workers with mobile phones so they can call them out when they're needed. They are able to recognise life-threatening conditions and they are pretty good at dealing with the minor issues in the villages and calling the motorbike ambulance out for the life-threatening cases.

"Two-thirds of journeys are maternal calls but the ambulances are also conveying patients with malaria, trauma, serious burns and other illnesses and injuries."

PONT is also helping to transform the care given to pregnant women and sick patients at the 400-bed Regional Referral Hospital in Mbale, which is the main hospital for nine districts in eastern Uganda. There are 30 doctors working at the hospital serving a population of 3.5million people; less than a third of medical officers are in post and only half the required number of consultants.

Pregnant women, in varying stages of labour, wait outside in the heat, for their turn to be admitted to deliver their babies. Inside, conditions in the hospital are basic and the staff have only water to keep the environment clean and sterile. Simple solutions include introducing a board outside the labour unit, which records the name of the women waiting and when they were last examined. Funding from the Welsh Government has supplied sonic aids to listen to foetal heartbeats to the hospital and to three health centres - more women are now coming to these centres to hear their baby's heartbeat for the first time, at the same time their general health can be checked.

The team is also helping to reduce the number of babies born by caesarean section in Mbale Hospital and, as a result, helping to reduce the risk of women suffering an often fatal ruptured uterus because they've had so many previous sections.

PONT is now teaching neonatal resuscitation skills to maternity staff in Mbale; oxygen saturation monitors are being used in the obstetric theatre and it is working on securing a sustainable supply of detergent to ensure cleanliness. The maternity unit is also now using a reusable Kiwi ventouse cup - a suction cup, which helps to deliver the baby - in cases where women need an assisted birth, rather than moving straight to caesarean section.

Sean Watermeyer, a consultant obstetrician and gynaecologist at the Royal Glamorgan Hospital, in Llantrisant, said: "These Kiwi cups can be used for up to 100 deliveries and hopefully we'll start to see the caesarean rate start to fall. The figures show that since November 2011 the rate has been going down and we've been told by a consultant obstetrician colleague in Mbale that about 3% of all deliveries are now with ventouse - that's hugely exciting. "Another problem we hope to help with is light - when night falls, even if there are health professionals at a health centre there's no light so the women don't come. We're hoping to equip three community health centres with solar panel lighting which can be used all night and which has been funded by the Welsh Government."

If improvements in maternity care are being achieved through simple measures, then one of PONT's biggest health successes to date has been a high-tech solution - setting up a fully-functioning endoscopy service at Mbale Hospital, which is now being completely run by staff in Uganda.

Jean Johnson, endoscopy sister at the Royal Glamorgan Hospital, said: "Anyone in Mbale region who needed endoscopy would have had to go to the capital Kampala, which was a minimum of a five-hour drive, providing you had the transport and the petrol. The people of Mbale wanted to have some way of treating people closer to home.

"I first visited in 2007 and come home feeling very depressed thinking that it wasn't going to happen, mainly because of the state of the hospital. The area they wanted to use had hardly any roof on it; patients queued outside and the equipment was either not working, rusted up or so old that no one knew how to make it work."

Despite the physical problems, the team agreed to supply the equipment and training to Mbale Hospital on the understanding it would work in partnership with PONT to set the service up and sustain it, including funding endoscopy in the future.

The equipment was donated by Olympus and staff from the hospital visited Wales for training.

The healthcare links have helped to hone the skills of NHS staff in Cwm Taf Health Board who have been involved in the various projects. But they have also inspired individual acts of support and fundraising.

Diane Davies, bed manager at Royal Glamorgan Hospital, was moved to act after meeting 17-year-old George, who was paralysed from the chest down, at an orphanage in Mbale on a PONT visit in 2010.

"I saw this boy dragging himself across the gravel to reach a chair; once there he was lifted up and put into the chair. It was a makeshift wheelchair made from a patio chair with wheels and plastic bottles for brakes," she said.

"I thought: 'If I'm going to change one person's life while I'm out here, it's going to be his'."

Diane talked about George on her return to Wales and, through a friend, discovered a company willing to donate him a new wheelchair.

She returned to Mbale last year with the chair.

"There was a single tear running down his cheek when he got the chair," she said.


* Dr Cath Taylor, a GP who leads PONT's primary care team talks to motorbikeambulance driver Joseph Nataka in Bushika, eastern Uganda * Operational level health practitioners in Mbale, Uganda, test drive the prototype Almobile stretchers, developed by PONT
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Title Annotation:Features
Publication:Western Mail (Cardiff, Wales)
Geographic Code:6UGAN
Date:Aug 13, 2012
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