It was decided that we would be picked up by Sr. Sigfrieda and Godfrey (driver) in Masaka, Uganda which was about halfway between Mbarara and Lweza. We stayed at the Cannosians Sisters compound which houses convent, health centre, and primary school. The buildings are brick and quite clean with groomed grounds.
It is also next to church and a rectory currently under construction. Road to the main road is very rough and parish priest requested for special funds at mass.
Lweza is about 20 km south of Kampala, the capital of Uganda, near the highway leading to Entebbe International Airport, which is 30km away. The density of population is high (about 450 people per square km). The standard of living is low, the houses in the surrounding villages and towns are poor. About 60% of the population are unemployed, the main sources of income are small shops and service outlets, agriculture, transport (boda - boda motorbikes). Part of the village area is a slum inhabited by very poor people who have no access to water or electricity. The natural environment is very polluted due to the proximity of a large city, factories, car traffic. Water in the rivers contains sewage and garbage, the soil is contaminated, the center is very noisy.
About 20% of families are marriages, about 50% of families are single-parent families. The problem is alcohol abuse, the percentage of smokers and drug addicts is small. The average number of children in families is 4-5.
Annually, almost 1,000 children are born in Lveza, 90% of births take place with the presence of medical staff, including 60% in the hospital. 9% give birth at home with TBA. The nearest maternity hospital is in Kisubi, 23 km away. About 30% of births are extra-marital, about 5% of newborns are born to mothers under 16 years of age. The percentage of prematurity is high (30%). The percentage of HIV infected mothers is 20%. Many children die during pregnancy and childbirth, maternal morality ratio is around 250 per 100,000 live births.
When the obstetric part of the Medical Center in Lweza starts working, there should be no problems with the availability of medical staff. There are 2 doctors, 3 midwives and 4 nurses working in the Center. 24-hour anesthetic care is available.
The Center provides advice on natural family planning methods. There is one portable ultrasound device. All basic laboratory tests and medication are available.
In the immediate vicinity of the Center there is an area with a separate outside entrance intended for future maternity services only. A decorative fountain was built in one of the corners of the yard.
The first building with a terrace in front of the entrance was used as the tailoring school before. It has three large rooms and three smaller ones. The antenatal ward was planned there - consisting of two large rooms without access to water, a delivery room with two delivery beds, a room for medical equipment, and a toilet and a shower for staff. Patient's toilet is outside with difficult access. The attic of the building can be reached from the delivery room. It is possible to bring water to one of the large rooms.
The second, smaller building with a very complex arrangement of rooms was intended for the postpartum ward. In our opinion, the postpartum ward should be located in the first large room of the first building and the second building can be used for obstetrics and gynecology outpatient clinic.
In the third building, two private postpartum apartments were located. The second and third building are already finished from the inside and outside. In the first building the works are still ongoing and there is still a lot of work to be done.
The pavement is being laid in the yard of the obstetric part.
We reviewed the proposed layout the sisters envisioned for the buildings; prenatal and postnatal wards of 10 bed each along with 2 delivery rooms. Sluice room and a bathroom and shower for staff. We were confused by the layout and agreed that more thought would be required to make the unit functionable. The newly constructed toilets were behind this building. Pregnant mothers would have to walk down some stairs, walk 10 ft and then back up stairs all of which is not covered which would create an unnecessary danger to mothers. I suggested that this needs to be leveled as well as covered. We suggested one of the inside bathrooms be used by pregnant women which sister thought was good idea to which I asked what would the newly constructed toilets be used for then.
There seems to be a real need to support the sisters and guide them with the maternity unit.
We met with Sr. Sigfrieda and another sister the next day. I asked if we were visiting any of the villages or slums that the sisters provide services. We were not as there was no outreach scheduled at the time of our visit. The closest hospital for any high-risk mothers was 12 kms away. Transport was not a problem given the area they are in.
We asked what the sisters plans regarding expanding the maternity services and how they would get mothers to come for prenatal care and delivery. Word of mouth and outreach clinics would get the word out of the services at the health centre. They believe they would get 60 deliveries a month at their health centre. Basic delivery with no other services is 200 000 UGSH.
We asked what the sisters needed. They were out of money to complete the renovation to the maternity unit. They requested equipment, beds, chairs, deliver beds etc… I said until they know how many beds for pre and postnatal, there was no sense ordering equipment. I requested a copy of the renovation contract. I also requested building plans for the 3 buildings to help maximize the functionality of the centre.
Sr. Sigfrieda took us to the Martyrs Shrine near Kampala. We toured the Basilica and met with the parish priest, Fr. Wojtek Ulman, from Poland. He knew of MaterCare and had previously corresponded with Dr. Chazan about their hospital, Wanda, and had requested help with maternity unit years prior. We were occupied with Project Isiolo at the time. Unfortunately, we did not have any time to visit, Wanda hospital but we did agree to visit and possibly explore a project there on our next visit to Uganda.