By Wasswa Deo
Healthcare organizations that are supporting people living with HIV/AIDS which includes People in Need Agency Uganda (PINA-U) and Aids Healthcare foundation, have urged the Ministry of Health to come out and clarify the government’s plans to initiate third line treatment for patients who have failed second line treatment.
Moses Nsubuga, the executive director People in need agency Uganda (PINA-U) says, the exclusive sources shows that the ministry has already setup a technical working committee to work on initiating the third line intervention, but if it’s true, the ministry should engage them in fighting the cause.
The two years study code named, Managing Using Latest Technologies to Save People Who Have Failed Second Line at Joint clinical research center, has over 270 Ugandans that have failed second line treatment
The organizations also want the government to come up with more innovative ways of ensuring people living with HIV/AIDS adhere to in taking their drugs. They say many of people living with HIV especially children have become drug resistant because they have poor adherence in taking their drugs.
Patients, who don’t make it to Moroto Regional Referral Hospital by midday, return home without treatment because the Outpatient department operates half day, URN reports.
Our reporter spent two days at the Hospital and observed that majority of the medics start work past 9:00am and leave by 2:00pm depending on the number of patients available.
Patients start lining up for treatment as soon as the OPD is opened at 7:00am. Patients who come past midday are bounced or ignored by staff.
Maria Ngorok trekked over 50 kilometers from Lotome in Napak district to Moroto Regional Referral Hospital with her husband and arrived at the hospital at 3:00pm on Tuesday.
However, they found the OPD closed leaving them with nowhere to turn for treatment. Ngorok noted that the journey to the hospital took them long since her husband was very ill, but they were disappointed to find the facility closed.
Phillip Longole, a patient from Iriiri Sub County in Napak district, approximately 100 kilometers away from Moroto, arrived at the Hospital just a few minutes past 4:00pm.
Longole, who traveled to the hospital by bus on Tuesday, lay helpless as there was no body to attend to him. He told URN with difficulty how he was desperate for the treatment.
By 6:00pm on Tuesday when URN left the hospital more than five patients including casualties lay unattended to at the casualty unit, the only unit left open in the OPD.
Other patients sought to join the wards that appear to have staff working throughout but those with limited knowledge on how the hospital works end up going back home or resort to clinics if they can afford.
Dr. Alfred Francis Ogwang, the Director Moroto Regional Referral Hospital acknowledges the challenge but attributes it to low staffing. He said the few staff at the OPD work for only one shift while emergency cases are rushed to the wards.
But Christine Alupo, a patient found in one of the clinics says the medics employed by the hospital spend most of their time in their businesses especially running private clinics.
Moroto Regional Referral Hospital serves the seven districts of Karamoja and neighboring communities from Teso and Kenya among others.
Common painkillers such as ibuprofen and naproxen are already known to raise people’s risk of a heart attack. Now a new study shows the risk comes within the first week of using the drugs.
The study doesn’t mean that everyone should avoid taking the pills to treat headaches, lower fevers and reduce aches and pains, but does suggest people who know they have a bigger-than-average heart attack risk should avoid long-term use and high doses, the researchers said.NBC News
The study involves drugs called nonsteroidal anti-inflammatory drugs or NSAIDS for short. They include ibuprofen, sold under brand names like Advil or Motrin; naproxen, like Aleve; as well as prescription arthritis drugs known as COX-2 inhibitors, such as Celebrex.
Tylenol, known generically as acetaminophen, is not an NSAID. The researchers did not look at aspirin, another NSAID commonly prescribed to lower heart attack risk that works in a slightly different manner.
The study also looked at Vioxx, a prescription drug pulled from the market in 2004 after it was shown to raise the risk of strokes and heart attacks.
Michèle Bally of McGill University and colleagues pooled all the studies they could find on NSAIDs and heart attacks. They settled on data covering 446,000 people using NSAIDs, including 385,000 who did not have heart attacks, known medically as myocardial infarctions.
“By studying 61,460 myocardial infarction events in real-world use of NSAIDs, we found that current use of a NSAID is associated with a significantly increased risk of acute myocardial infarction,” they wrote in their report, published in the British Medical Journal.
The risk started within a week and it did not grow with longer use, they found. But the study doesn’t show just how much someone’s risk of having a heart attack is increased.
“This was observed for all traditional NSAIDs, including naproxen,” they added.
Using more than 1,200 mg a day of ibuprofen and 750 mg a day of naproxen was especially dangerous, they found. As expected, Vioxx was especially dangerous.
Moroto district health officer, Dr Abubaker Lubega, may be in trouble after the Hepatitis B vaccines worth 900 million shillings expired in the stores.
The expiry of drugs has caused a rift between Dr Lubega, the district leadership and members of staff in the district health department.
Information obtained by URN indicates that 18,000 doses of Hepatitis B vaccines were exposed to high temperatures leading to their expiry.
Peter Amei, who’s in charge of disease surveillance in the district on Wednesday openly blamed Dr Lubega for reportedly ignoring the advice given by the cold chain manager on the storage of drugs. Amei said the cold chain manager requested for money several times to improvise alternative power source for the vaccines in case of electricity shortage but it was turned down.
But Dr Lubega in an interview with URN blames his staff for negligence and breakdown of the cool chain system. He says the expiry of vaccines in stores was a deliberate move by the cold chain manager in order to cause him problems. He explains that the power equipment was vandalised by some of the staff that he declined to name.
Peter Ken Lochap, the RDC Moroto says he asked police to investigate the matter and and have the responsible officers brought to book. He notes that the negligence by officers has not only affected the community but also government which has incurred a great loss.
Karamoja region has the highest prevalence rate of Hepatitis B at 23 percent in the entire country followed by Lango and Acholi with 19 percent according to statistics from the Ministry of Health.
Whereas a good number of people have been vaccinated against Hepatitis B, thousands others are yet to complete their doses.
Jinja Regional Referral Hospital is struggling to deal with mental health patients due to numerous challenges. Edith Alitwala, a senior Nursing Officer in the Psychiatry Department, says there are only four nurses instead of 8.
According to Alitwala, the number of mental health patients has almost doubled in the previous three months. She explains that they used to receive between 20 and 30 patients daily, but the number has increased to over 60 patients.
URN spoke to Sarah Mudondo, a care take to one of the patients who has spent four weeks in the facility. She says that she spends more than Shillings 20,000 on drugs and food daily.
Alitwala emphasizes that the failure by the hospital to provide meals to the patients is a big setback. She says that in most cases they are forced to suspend medication to patients especially with HIV when they learn that the patient has not eaten.
She also cited insecurity as another challenge in the hospital. The mental health unit relies on the guards at the main gate, which is a very long distance from the unit.
“We have two nurses on night duty and there is a time when a patient wanted to strangle a nurse. They had had to call security personnel at the main entrance, which is very risky,” she said.
The Mental health department of Jinja Regional Referral Hospital was established in 2010 following the decentralization of mental healthcare to regional referral hospitals to reduce at Butabika Referral Hospital.
Insomnia is excruciatingly tiring to deal with. It incapacitates you by making you unable to deal with changes — it took me 2 days to shift my schedule around so that I could have enough time last night to prepare for deep sleep. But all it took was a text message to send my mental state into anxiety, worry, depression, all at once. I laid in bed wide awake for 5 hours and towards the end, thought about how productive I could have been, if I hadn’t spent all this time lying on the bed.
When you don’t get enough sleep, you are never fully present in the moment. Tiredness looms over your whole presence. Productiveness decreases. You turn up late, or you miss meetings in the morning because that’s the time when you start to fall asleep — and you refuse to let anything get in the way. Guilt consumes you.
You feel hopeless, worthless, and cancel on anything that makes you anxious, and everything makes you anxious and annoyed, even people on the train chatting on their phones. Whenever you’re present in a class, or at a meeting, it takes you tremendous effort and courage. You feel like you’ve conquered something, until you realise that you’re putting in so much effort for something that requires minimal effort for others, and start to despair.
The emotional detriments of insomnia is an endless cycle of guilt, tiredness and hopelessness. Trying to escape drains both willpower and reputation.
Reputation, because insomnia is not an excuse, and neither is depression. Wanting to sleep is seen as lazy. Not sleeping earlier is seen as a mismanagement of time. To the working world, the dark rings under your eyes represent no more than inefficiency as a human being.
They tell you that they understand you, and give recount of that one time when they stayed up all night, not knowing you’ve been awake for 3 days straight more times than you can remember. They give advice on scented candles, and classical music, not knowing that you’ve tried even alcohol in desperation. You thank them for their good will, while they walk away wondering why you’re too stubborn to take their advice. They shake their heads at you.
But insomnia is not just insomnia. Insomnia is often a symptom of something larger that should be solved. Of health problems. Of mental discomfort. Insomnia is a symptom that aggravates the already aggravated situation. It traps you and eventually consumes you, making you question your sanity every night when you lay in bed with an overactive mind, thinking about all the mistakes in your life. It doesn’t help that insomnia has high comorbidity with depression and anxiety, all of which rides on each other to escalate the demise of your mind.
There is no easy solution to sleeplessness, because the causes are so diverse. This is a picture of what insomnia can be, and the hidden emotional costs of this debilitating condition.
“ Are you going to sleep soon? “
“ I try.”
But Joshua Sikhu Okonya, a research associate with International Potato Center’s Crop and Systems Sciences Division says that the absence of extension services and other safeguards is making the increased use of pesticides disastrous.
Okonya, who has conducted a number of surveys around pesticide use in the country, says farmers have tended to apply pesticides even at times when the threat is not that enormous. He says dealers tend to profiteer in selling pesticides to unsuspecting farmers.
Okonya’s most recent studies involved pesticide use and knowledge of smallholder potato farmers in Uganda involving districts in the Albert, South Western highlands and eastern highlands.
45 percent of the farmers according to findings of the survey received information about which pesticide to use from other farmers. Only two percent of them received information directly from agricultural extension officers.
When it came to the doses of pesticides, most farmers in the southwestern highlands and eastern highlands relied mostly on their own previous experience.
On average, findings of the study published by BioMed Research International indicated that agro-input shops were the primary source of pesticides in the three agro ecological zones, followed by general household merchandise.
Farmers in all the three agro ecological zones reported some health-related complications resulting from pesticide use. All those that got infections according to Okonya thought it was normal.
Okonya says crops can only be sprayed against fungicides and pests when the perceived damage is likely to be above a given threshold. He adds that other control measures like Integrated Pest Management (IPM) can be applied other than depending on costly pesticides and fungicides.
A study commissioned by Ministry Agriculture in 2014 found that pesticide use was largely poorly regulated. It said monitoring and regulation of the sectors require USD 15 million (53 billion Shillings).
The environment study conducted by Nelson and Associates Environment consultancy said there is lack of human resources to inspect and enforce regulations.
National environment Management Authority has warned that the contamination of water bodies with pesticides can pose a significant threat to aquatic ecosystems and drinking water resources.
Source Of Pesticides
There are no agricultural pesticides manufactured or formulated in Uganda. Suppliers of imported pesticides come mainly from India, China, Taiwan, Israel, Europe or branch offices of international companies in Kenya.
Nelson and Associates Environment Consultancy found another challenge with how to dispose agrochemicals and generally pesticides. Only UPDF-owned Luwero Industries would meet requirements for incinerating pesticides.