The team traveled to Kasensero on the 31st May to set up the camp for the following day. Our team was made up of over 50 members coming from Kampala, the USA, and the Rakai district. Accommodations were obtained in the local lodges and meals were catered by a local restaurant. On the day of arrival, the team met for a second briefing where we met the Rakai district team for the first time. Allocation of different tasks and responsibilities were discussed under the cover of darkness and a moonlit sky.

Day one of the camp started at 6 AM with the creation of different stations. The local HIV clinic building served as the central camp site, however other stations were organized, one at the local government health center II, as well as a small HDU housed in a local church close to the main camp area. Unfortunately our tents were delayed in arriving, but when they did show up later in the afternoon, more stations were created.

• All patients were registered, given numbers and a short personal history was taken.

• The triage center was manned by six (6) nurses and various medical students who recorded all the patient’s necessary vitals including BP, temperature, weight, height, SPO2, pulse and respiratory rate. Patients who were triaged red were taken for critical care and attended to first. Those triaged blue and yellow were directed to the alternative stations for evaluations.

• Nine (9) doctor’s stations where created with the staff we had available. Medical forms from the ministry of health, plain paper, and note books were employed to document patient findings.

• We staffed one laboratory station with 5 attendants running basic tests including HIV, B/S, RDT, TPHA, urine HCG and urinalysis.

• All supplies were housed in a storeroom manned by one CHF nurse who monitored and accounted for all stock moving in and out.

• Two drug dispensing and administration stations where created and manned by 7 nurses and prescription dispensers.

• An HIV testing and counseling station was created within the confines of the local HIV clinic for privacy and accuracy, and was staffed by specialized HIV counselors, a lab tech and nurses.

• Mothers and children were seen at the local government heath center II by doctors, medical students, and a US pediatrician. This arrangement decongested the main camp site.

• The high dependency unit was located at a local church was manned by Dr. Charles. All IV drugs and fluids where administered from here, some minor surgical procedures performed and arrangements for hospital transferred were organized.

• The central waiting area was provided with music from the PA system interspersed with intervals of evangelism and gospel preaching.

Many disease conditions were seen and treated however some of the commonest conditions observed during the camp included;

• HIV/AIDS

• Opportunistic infection mostly PTB, Pneumonias, skin diseases, and KS.

• Syphilis

• Candidiasis

• PID

• Eye and dental pathology

• Diarrheal diseases and malnutrition among the children

After the first day, a debriefing meeting was held with all participants to evaluate the performances. Appraisals and adjustments were made and the team was congratulated for their efforts and hard work.

The second day flowed better since adjustments were put into place and fewer numbers of patients were seen as compared to the first day. The camp was closed at around 3 PM by the RDC. Speeches from the local leaders, the RDC and CHF team leaders were made. CHF concluded our efforts by donating most of the remaining drugs and medical supplies to the local health center II for continuity of care.

Our main points of referral were Kakuto Health Center IV in Rakai, Masaka Hospital and Mulago Hospital Kampala. Two very sick children were transferred to Masaka Hospital with severe malnutrition and ISS with sepsis. CHF provided transportation to the hospital and both children were admitted. Two cases were referred to Mulago Hospital, admitted, and CHF is overseeing their care.

MAJOR ACHIEVEMENTS

The camp was very successful with nearly 1400 patients seen during the two day event. 354 people were tested for HIV, and 8 men and 7 women were confirmed with HIV by parallel testing. These individuals were counseled and results and follow up instructions were given. District schools brought over 250 children for assessment and care, and these were given exams and provided with vitamin supplements in addition to the medicines individuals received.

CHALLENGES

Many challenges where faced during the event, however the team overcame most of these ensuring the success of the camp. Some of the challenges included:

• The gravel road to Kasensero was in poor condition, since this was the rainy season. Many points along the road were flooded and pitted with big pot holes. Fortunately our team traveled with a four wheel drive vehicle and navigated the road without difficulty.

• During the first day of the camp, rain was inconveniencing and disrupted activities for an hour.

• The tent stations for the camp were delayed in arriving onsite and this led to fewer stations the first morning.

• The projected patient number of 400 turned out to be quite low compared to the actual 850 patients we treated on the first day and the 442 we saw on day two. This discrepancy created many deficiencies in our drug and medical supply line. This problem was overcome by an emergency “drug run” to Masaka to purchase the needed inventory that was lacking.

• Documentation of the patient’s condition was challenging in light of the fact we had insufficient forms and had to rely on cruder methods of record keeping. The proper medical forms were too few in number due to our underestimation of patient volume.

• At times the food caterer arrived late with the meals and some complained of that the quality of the food was substandard.

• We had limited private examination rooms since most rooms were already in use for other purposes.

• We lacked some medical specialists like ophthalmology, orthopedics, ENT, and dentists. We could use extra pediatricians as well due to the number of pediatric cases we had.

RECOMMENDATIONS

• Due to the camp’s success, response and requests of the Rakai government officials, and the local community, another camp is recommended to be organized in June of next year (2013).

• There is a need for organizational planning to begin earlier with close communication with all interested parties onsite to begin a minimum of 6 months prior to the event for optimum efficiency. Monthly goals should be set and met to reduce “last minute” stress.

• Straight forward communication and “timely” cooperation with the Rakai District Health officials is needed to insure a smooth working relationship with the Kampala team members.

• More medical specialists need to be included in the next team.

• Supplies should be stockpiled earlier and estimated projections should be dependent on this past camp experience and expected patient turn out.

• Advance team members should be onsite 24 hours before the event to ensure all local logistic needs are completely set up prior to commencing patient care.

• Possible use of a government vehicle to be used as an ambulance transport for critical patients needs to be considered.

• Alternative food catering services need to be considered as well as the cost for food transport itself.

• Transporting in portable toilets for the event should be considered due to Kasensero’s limited sanitation facilities, expected high volumes of patients, and convenience of the team members.

• Expectation of clean and ample rooms along with shower facilities for all team members.

• All regional hospitals should be contacted prior to the event to inform them of possible transfers.

• Increase the number of pharmaceutical dispensaries and locate them at various sites throughout the camp to reduce patient congestion.

• Increase the number of tents due to probable increase of projected patient volume next time.

• Utilize the local HIV clinic only for HIV testing and counseling to reduce patient congestion.

• Gain permission of the local nearby church to set up private exam rooms and Urgent Care Unit within the building for IVs, genital exams, and other “invasive” situations.

• The challenges experienced in this camp should be reviewed and solutions identified prior to next year’s event.

CONCLUSION

The camp was well organized despite some miscalculations on patient turn out. The donations received were greatly helpful since the original budget estimate totaled over 45 million UGX. All patients who arrived at the camp were seen and treated while a few were referred. All team members and interested parties who contributed to the success of this camp were awarded with certificates and letters of appreciation. The organizing committee for this camp wishes to extend our appreciation and sincere gratitude to everyone who participated in this camp. May the Good Lord reward you all
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