Shifting gears - from planning to implementation
Last week I traveled to the district of Kibaale in Bunyoro-Kitara, western Uganda, to assess the readiness of some of the Infectious Diseases Institute (IDI)’s Outreach sites for participating in clinical trials. Now that I’ve outlined IDI’s strategic plan for research it’s time to start working out the detail of how to put the high level plans into practice.
During my stay I visited the District Hospital of Kagadi, which has 160 beds; a recently refurbished operating theater that conducts about 50 obstetric surgeries per month; and a fully equipped lab for hematology, chemistry, microbiology and immunology testing. Kibaale District also has 4 government-funded and one private Health Center IV’s, over 20 Health Center III’s that provide maternity and basic lab services and a number Health Center II’s that provide basic health care, as well as 1800 Village Health Team workers that provide health information to village households.
Malaria is the major health issue in the district and I observed as several feverish children were tested for malaria in the lab at a Health Center III with a finger prick and rapid diagnostic test kit; all the children tested positive. Several new drugs for resistant strains of malaria are in development; IDI has ready access to malaria patients in the District for enrollment into clinical trials.
While the trained staff, new equipment and patients necessary for clinical trials are all in place at the District sites, more fundamental issues exist. The hospital has frequent power outages and lacks fuel to run its generator, so all the staff can do is wait until power is restored before they can continue providing services and operating power-hungry lab equipment. Some of the health centers have severe staff shortages and the current staff are spread too thin and are literally exhausted in trying to meet the local demand for health care.
The good news is that the district sites appear to be capable of participating in clinical trials. However IDI will need to pay careful attention to the basics and ensure that sites have adequate power and running water, and that patients have adequate access to health centers, with transport assistance if needed. In particular, centers that are understaffed may not have the manpower to cope with the demands of a clinical trial on top of providing routine care; some strategic selection of sites based on staffing level is needed. Through its Outreach program, IDI has already done much to build the capabilities of the district and provided the more basic issues can be addressed, the future for research in the region looks bright.