MBA Student's Journey to Kawolo Hospital: Kawolo, Uganda

December 7th, 2010: Journey to Kawolo Hospital; Kawolo, Uganda
Nadia Abuzaineh and Adam Wolf

After spending several days exploring the wide landscape of urban hospitals in Kampala, Uganda, we journeyed out to Kawolo Hospital, a truly rural 100 bed hospital about 45 kilometers outside of the city center in Kawolo. The drive in and of itself was quite a journey as we quickly realized that a drive that would normally take about 20 minutes, would instead take over two hours due to the extremely poor road conditions.
Upon arriving at the hospital, which was situated directly off of the main road into Kampala, we found a collection of buildings which appeared to be abandoned. There was no one in any of the administrative offices and all we heard was the heart-wrenching scream of what appeared to be a young child in extreme pain. We were shortly approached by a young woman who helped us locate the one doctor on call.
We then met Dr. Julius Kizito who, after training at Markere University in Kampala, returned to his hometown to work as one of the three doctors at Kawolo. Despite having over 100 beds, serving over 300 patients a day, and performing over 15 major surgeries daily, the hospital only had 3 doctors, an astonishingly low number for the medical needs of the area. We also learned that one doctor had been offsite on training for over a month, leaving just 2 doctors to cover the immense medical and surgical load. When asked what drove him to return to Kawolo, Dr. Kizito simply said, “this is my hometown; I always knew I would come back.”
In an effort to learn a little more about the types of needs at Kawolo, we learned that roadside and vehicle related injuries and fatalities were by far the predominate medical issue treated at Kawolo. After hearing this and experiencing the driving conditions first hand, one can’t help to wonder if the burden on the medical field could be reduced to a great extent by simply installing more stoplights and putting a greater emphasis on vehicle safety.
As we turned our discussion to some of the preliminary suggestions we had developed to increase the surgical capacity in rural areas, Dr. Kizito was excited to hear about a substitute surgeon program we had been developing. Although in the past surgeons in Kampala were mandated to serve in rural areas for several weeks a year, this program had been cut due to a lack of funding. As a result, when one of the three doctors was away for training or family matters at Kawolo, the entire burden feel on the remaining doctors. With a program where a substitute surgeon could be sent to handle the duties of the missing doctor, Dr. Kizito was optimistic that this would increase the quality of care not only by increasing capacity, but also by reducing the fatigue of the doctors who remained at Kawolo.
After our 2 hour journey back to Kampala, although we were certainly impacted by the extremely poor conditions at Kawolo, we were excited to hear that one of the recommendations we had been working on, the substitute surgeon program, would be of great benefit to a hospital like Kawolo. It was then off to sleep before an early morning flight to Nairobi, Kenya.

MBA Student's Journey To Tanzania

Day 1 – Dar Es Salaam, Tanzania (Adam Wolf)

This was the first day of interviews in Tanzania for Nadia and myself and we weren’t quite sure what to expect. We had arranged an office visit with Andy Wilson, who manages the Abbott Fund operations and programs in Tanzania. After what was to become our staple breakfast of omelets and toast, we were picked up by Andy at 9am sharp and taken through the maze of traffic to the Abbott Fund offices in downtown.
Our hour long meeting with Andy turned out to be one of the most productive and insightful ones of the entire trip. The Abbott Fund seems to have really gotten the grasp of “impactful-aid”. While a number of other international NGOs and charitable foundations seem to blindly give away their dollars, the Abbott Fund has a strong understanding of the major needs of the country and where foreign dollars could be the most impactful.
The Abbott Fund, focuses on three main areas:
- Nutrition
- Access to Healthcare (mainly healthcare systems)
- HIV/AIDS (ex. PMTCT,treatment, infrastructure, pediatric AIDS)

Major Programs in place:
• Building fully functional laboratories in all 23 regions in Tanzania. By March 2011, all labs are expected to be up and running. Prior to this, lab testing for diseases such as TB and malaria was not possible, making treatment even more challenging. This was eye opening for me since international focus seems to be on alleviating disease without consideration to the major issue of actually being able to identify or diagnose a disease condition. The Abbott Fund also realizes the importance of equipment maintenance in creating a sustainable model of care and is also in the process of training local technicians in each region in the basics of lab equipment maintenance.
• Building and supplying the first emergency department in a public institution in the whole country (traction for this initiative was achieved by establishing a partnership with the ministry of health)
The Emergency Department at Muhimbili Hospital
The emergency department facility was built by the Abbott Fund and is staffed by Muhimbili. In my eyes, it’s the perfect example of how supplies, infrastructure and workforce are all essential in building a truly successful capacity building program. Prior to this, 7-8 people would die a day as a result of trauma. After the introduction of the ER, 5 of these lives is being saved on a daily basis.
The fund is also responsible for instituting the first ever national ER curriculum for doctors and nurses. The initiative is being spearheaded by Dr. Alwyn Mziray, a Tanzanian local who was trained in the US. This further adds to the value of the program as he is able to pull best practices of the American medical school curriculum into Muhimbili training. In addition, he often uses his network to invite doctors and residents to the Mihimbili ER, further adding to the quality of the training experience.
Our experience at Muhimbili is a testament to the fact that you should never make assumptions and leave any avenue unexplored. What we expected to be a short visit to talk through lab facilities turned into a truly memorable and insightful experience. We thank Andy Wilson and his whole team for their hospitality and for their eagerness in sharing their experiences.