Health workers manning five health centres in two refugee camps in the southwestern Ugandan district of Isingiro say they are overwhelmed by the high number of refugees and local residents in need of HIV services.
Severe personnel shortages in Nakivale and Oruchinga refugee settlements have led to long queues at the clinics and placed a heavy burden on the few health workers available, many of whom often have to take double shifts to meet demand.
"It's the same staff to do ward work and carry out sensitization and awareness campaigns to increase the refugees' understanding of HIV/AIDS, and how to prevent transmitting the disease," said Dr Chris Omara, health coordinator for Medical Teams International (MTI), a medical NGO that works in humanitarian emergencies.
MTI runs two clinics of its own and supports three government health centres in the settlements. Some 180 health workers, only three of whom are doctors, are responsible for a population of over 139,000 people - 63,749 refugees and more than 76,000 local residents - in the area, which has an HIV prevalence of 6 percent.
The UN Refugee Agency, which provides MTI with US$2 per refugee per year for medication, says it difficult to recruit and retain health personnel to work among Uganda's refugee populations.
Dr Isaac Odongo, MTI's regional programme manager for southwestern Uganda, noted that the need for information on HIV and sexually transmitted infections (STIs) was crucial for refugees, many of whom came from conflict-prone areas of the Democratic republic of Congo (DRC) where such information was hard to come by.
"The HIV infection rates are generally low among the refugees when they just come [but] with time, they get into reckless activities [unprotected sex] with locals and they get infected," he said.
Uganda suffers from a chronic shortage of health workers - less than half of the vacant health positions are filled - but the recent influx of refugees fleeing violence in neighbouring DRC has put even more pressure on Isingiro's health services.
MTI replaced the German NGO, Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) [German Agency for international Cooperation] in the area three months ago, and one MTI official, who spoke on condition of anonymity, said the transition had also affected the smooth provision of HIV services to patients.
"We have just been in the field for three months. It's not easy to have all the patients on board. There are also issues to do with procurement and requisition of ARVs [antiretrovirals] and TB drugs," said the official.
At one of the health centres in Nakivale refugee settlement there are 69 HIV-exposed infants who need close monitoring and supervision. However, the health centre has only one general doctor, Dr Gideon Ndaula, who has to see HIV-positive people as well as other patients, and the same scenario is repeated in health centres across the settlement.
On the day IRIN/PlusNews visited the facility, Ndaula was performing male circumcisions and was unable to attend to other patients. Uganda's Ministry of Health has embarked on a large-scale voluntary medical male circumcision programme as part of HIV prevention efforts.
Follow-up is another major problem. The fear of stigmatization causes many local people and refugees to limit their attendance at the health centre to the bare minimum.
|At times we have come here [to the health centre] and there are no drugs. As for me, I can't afford to buy ARVs and TB drugs|
"We have a challenge in following and monitoring some cases, especially among the nationals. They come once and don't return. When the disease worsens, it's not easy for us to follow," said Ndaula.
Health workers are often too busy to provide counselling on infant feeding for HIV-positive mothers, many of whom could infect their babies through incorrect feeding methods.
Florence Ajonye, the HIV/AIDS focal person at the heal facility in Nakivale settlement, told IRIN/PlusNews that patients often had to wait to be enrolled on life-prolonging ARV drugs, even when they qualified.
"There are so many patients here to see. The doctor sees between 30 and 50 [every day] - far too many to ensure adequate attention. Sometimes people wait for hours to be attended to. As a result... we start with those who are critically ill," she said.
"The supplies are not enough. There are times we run short of ARVs and Septrin [an antibiotic used to prevent opportunistic infections] for our patients. We have to either request from the other facilities or have to buy the drugs to… [ensure] continuity of the services."
"At times we have come here [the health centre] and found no drugs," said one patient. "As for me, I can't manage to buy ARVs and TB drugs in Isingiro or Mbarara [another western Ugandan town]."