Getting Acquainted With KIHEFO-A Local Ugandan Development Organization

It's a strange feeling when you finally come to meet things in real life you've observed so closely in photographs and heard about through stories. Certainly a good feeling knowing the journey was not short. When I found myself standing in front of KIHEFO's Kigonzi General Clinic and HIV/AIDS Clinic and Outreach Center, with the Nutrition and Rehabilitation Center just behind, it was comforting knowing I had made it. My feet were finally on the ground in Kabale, the orange colored dust from the road coating my shoes, and the anticipation of meeting great people and doing great things was behind me. The time had come to learn firsthand.

KIHEFO's HIV/AIDS Clinic & Outreach Center

The beginning of KIHEFO's story is attributed to Dr. Geoffrey Anguyo, a fiercely admired local physician and visionary who, more than a decade ago, shouldered the responsibility of providing the community with essential health services in response to the government's extreme shortcomings. As a physician employed at the local government hospital, Kabale Regional Hospital, trying desperately to provide medical care in appalling conditions, he felt he was not doing enough for the community. This bold decision to leave eventually gave rise to KIHEFO-a community-led development organization that aims to fight disease, poverty, and ignorance in southwestern Uganda, including hard to reach rural populations that have been largely neglected and are most in need. Moving forward, KIHEFO is beginning to grow. "KIHEFO does not belong to one man, it belongs to the society. It is an organization of the many,"-Robert, KIHEFO Community Organizer.

Coincidentally, I had the honor of meeting Dr. Geoffrey in San Francisco, California-on my side of the world. A strong presence, in build and character. He shared a story about pineapples in his youth and how they came to represent empowerment. As a teenager selling pineapples he was able to pay school fees and proceed with his education. This simple, yet significant, experience led to the realization that if you provide someone with a modest means of survival they then have an effective tool to apply their potential. He said it has never been a question of whether people have potential, but rather how they can make use of it when odds are stacked against them.

KIHEFO is built on this idea of empowerment and emphasizes self-sustainability as a means towards overall well-being. It was firmly decided some time ago not to depend on the government or top down aid organizations for money. The frustrations in dealing with an unpredictable and largely corrupt government system, as well as a long list of strict compliances from international organizations, far outweighed the benefits. And so KIHEFO has managed to sustain themselves by charging reasonable patient service fees for those who are able, funds generated by Kigezi Tours-a branch of KIHEFO offering ecotourism-and forming partnerships with existing organizations, nationally and internationally. KIHEFO does not sit idle: programs and projects have continued to run by engaging the community. "The community is KIHEFO's greatest resource." Dr. Geoffrey emphasized.

Nearly ten years later the word is getting out about KIHEFO and people are expressing excitement and taking an active interest. Kabale, Uganda is on the map.

Allow the statistics to speak

KIHEFO deals with many things. Dr. Geoffrey mentioned that it seems more fitting to describe KIHEFO as a development organization rather than merely a healthcare organization, since their involvement in the community touches upon so many things. The current aim is to promote health, sustainable agriculture, income generation, and civic participation. When a need arises within the community that poses a health challenge it is addressed. Often the challenge can be prevented, and so it’s important to peel back the layers and discover the source of the problem.

Throughout the whole of Uganda the patient to doctor ratio is 100,000: 1. The average life span is 59 years of age. 80% of Ugandans are farmers. The Kigezi region of southwestern Uganda is home to an estimated 2 million people, with the majority of the population living in rural villages. There are roughly 20 physicians serving the regional population and not one, single dentist. The healthcare system functions poorly and is laden with corruption at many levels. Transparency International ranked Uganda amongst the top 25% most corrupt countries in the world in 2012. And although a steady decline has occurred, roughly 25% of all services carried out require a bribe. This makes it extremely challenging for health professionals to work within such an unjust system. Absenteeism is all too common and patients are left feeling abandoned.

Several of KIHEFO's greatest health challenges are malnutrition, maternal and child health, and HIV/AIDS.

Uganda is ranked 20th as having the highest rate of maternal mortality and the 15th highest rate of child mortality (< 5 y/o), according to the World Health Organization's 2012 Global Report. It is ranked 32nd out of 176 countries as being one of the toughest place for mothers to live. An enormous challenge for KIHEFO has been convincing women to deliver in the hospital. Of the 2 million people living in the Kigezi region, roughly 150,000 people reside in rural villages. 70% of women in the region are giving birth at home in rural villages, with only 30% delivering in adequate healthcare facilities. Fear of the hospital, a lack of awareness regarding benefits to delivering in hospital, an inability to afford maternal health services, and pressure from husbands to remain at home tending to the fields and family until delivery is imminent are several factors contributing to Uganda's grim standing in maternal and child health. On the bright side, more and more women are seeking antenatal care; even some traditional birth attendants are recommending it within the modern health system. Although Uganda is 8th among African countries making progress in reducing maternal mortality, efforts must greatly be enhanced to achieve Millenium Development Goal 4-reduced child mortality-and 5-improving maternal child health-by 2015.

Food security is plaguing the nation. A staggering 60% of children are suffering from malnutrition. With 80% of Ugandans dwelling in the countryside, the majority of families grow or herd their own food for a living. During the rainy season, crop yields can be generous and mothers are able to provide food for their children. However, during the dry season women are often forced to sell their crops in order to pay for other necessary expenses. In addition to the climate, knowledge as to what constitutes a well balanced diet and essential daily nutrients, is severely lacking. Dr. Geoffrey said, "As long as the child's belly is full, everything is okay." And when malnutrition sets in, parents are failing to recognize clear warning signs, never having been taught.

It is believed that the prevalence of HIV/AIDS within the region is increasing, especially amongst 15-20 y/o. Sensitization within the community is making a tremendous impact and people are confronting their HIV+ status.  Even still, high rates of infidelity, mostly on the part of men, resistance to contraceptives and family planning services, prostitution, stigma, poverty, and a lack of communication between partners about potential infection are strongly inhibiting progress. Many youth and young adults today were infected with HIV by their parents and are managing it well today. Ann, an HIV/AIDS counselor at KIHEFO said, "It's important for people in this generation to be mindful when engaging in sexual behavior because many of these people may not appear to be sick, despite their HIV+ status." Resources aimed at decreasing HIV/AIDS within Uganda appear to be available and the problem a high priority. However, it's absolutely essential for education efforts to continue within the community.

Julius, a Lab Technician at KIHEFO, at an HIV Community Outreach held near the Echuya Forest.

There is reason to hope at KIHEFO. Patience, diligence, and a continued strong regard for the community will, in time, garner additional support and bring about success.