Volunteer Memoirs; Carlos and Carolina Tovar

Almost three years ago Carlos and Carolina Tovar moved to Uganda to work for Kissito. They didn’t know what they were going to do, or how they were going to do it, but they knew God was calling them to be here, and be a part of the organization.

They packed their entire lives into 4 fifty-pound suitcases and started out on their journey. They only spoke Spanish, so when they got here they spent three months learning English in the capitol, knowing it would be worth it once they started working.

Before the guest house, and the generator, and the transportation that we have acquired over the years, the two of them lived right in the village. Power was rare and they had to walk or take public transportation to get anywhere, and the closest town was quite a ways away.

They eventually started working at the Bugobero Health Center, the one Kissito is almost completely accountable for now. They helped start the Wanale Emergency Nutrition Program too, which has helped hundreds of children to date.

They had decided to leave in September of 2012, but something was holding them back. They delayed their departure and at the end of September baby Isabella came into their lives.

She was only two weeks old and on the brink of death. Her mother had passed away delivering her and there was very little hope for her survival. Carolina knew this is why God had told them to stay in Uganda. After a couple of weeks helping care of Isabella her and Carlos sat down and decided they would adopt her.

The process wasn’t an easy one, nor a timely one. They spent six months and countless hours trying to get the paperwork, but in the middle of March it was official; they were parents!

They left on April 9th, but only physically; their kindness, inspiration, and unconditional love lives on. They weren’t just a couple of volunteers, they were the foundation, and the heart behind it all. They were like the parents in the guest house, always making sure the volunteers was completely comfortable. They were the words of wisdom, when the culture shock was too much, and the open ears when someone needed to talk.

The light of God shown through them each and everyday, and the work they did here has had an impact on not only the Kissito Family, but the community as a whole, and especially for that one beautiful baby girl.

We don’t want to see them go, but understand it is time for them to. There will always be a place for them in Kissito though, and their work is still an inspiration to us all!

We cannot say thank you enough, for their incredible service and dedication to the betterment of human life.

Findings from the Uganda research team

Photo by: April ParsonsLaura Fisher, with translation help from Uthman, surveys a patient at a health center.

Photo by: April Parsons
Laura Fisher, with translation help from Uthman, surveys a patient at a health center.

“We really should be working in all 69 of these health centers,” said Kissito President Tom Clarke one night, during a casual conversation at the Ugandan volunteer house. It was a simple statement that brought about one of the biggest tasks the KHI research team has ever taken on.

We knew they needed the help, and we knew we had help to give, but what were the specifics? That is what our key researchers Laura Fisher, and Doug Dasilva, have set out to find. Instead of just giving out goodie bags of gauze and gloves, or placing incubators in random facilities, the research team will be going into all 69 facilities in the Mbale, Manafwa and Baduda districts to find out what each facility needs; everything from the types of drugs, and supplies, to water and electricity, and to possible improvements on staff and patient satisfaction.

After a lot of hard work, literature reviews, and discussions with doctors they created a three-tier comprehensive study. The first part is a massive survey, 747 questions to be exact, that asks about every single drug, supply or piece of equipment that a health center would have. The second is health worker surveys, which get both qualitative and quantitative data; how often to they work, what do they need to better perform their job etc. The third is patient satisfaction surveys. They ask the patients about their experience at the health center; whether they knew what their diagnosis was, or when to take their medicine.


It’s been about two months and the research team is not even half way done with the baseline. Most facilities take anywhere from one to two hours to get to, and you could never complete the surveys at more than two health centers in a day (and that doesn’t include the document organizing or data entry!).

So far they have completed the entire Baduda district, and half of the Manafwa district. Although they have a long way to go, some of the statistics they have found already are quite surprising, and really tell a tale of just how much work we have cut out for us.

Data below is from 25 facilities – 4 Hospitals/Health center 4s, 11 health center 3s, and 10 health center 2s:

12% have running water from the city.

Only 60% have a functioning water tank.

That means 40% percent of facilities do not have water.

80% of facilities do not have electricity.

40% do not have nutrition patient education services

20% do not have a thermometer.

12% do not have a stethoscope.

76% do not have a measuring tape for height.

And only 24% of health facilities have access to an ambulance.

This is just the beginning of their assessment. They hope to have the surveys completed by the end of April and will then be able to give completely accurate statistics for the eastern region of Uganda.

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Virginia pastors to build church in Africa

Photo by: April ParsonsPastor Tony (left) with his delegation at the Butiru Cristco health center in Manafwa, Uganda.

Photo by: April Parsons
Pastor Tony (left) with his delegation at the Butiru Crisco health center in Manafwa, Uganda.

Almost a year ago, Tony, a pastor at New Life Christian Ministries, a church in Roanoke Virginia, decided to take a trip to Uganda with KHI President Tom Clarke. It was a trip that would inevitably change his life.

Ten months later he is on his second trip, along with five other pastors from Virginia, and they are making preparations to build a church.

“I really felt like God was calling me here,” said Pastor Tony. “There is so much good that can be done here, and I am really excited to see God’s plan for the work in Uganda.”

Pastor Tony has partnered with the Butiru Chrisco health center, only a few miles away from the KHI run Bugobero health center, as a foundation and home base for their work. At the same time, Kissito has also signed MOUs with the health center and will soon be putting our health system strengthening tactics in place.

“It’s a really great partnership,” said Pastor Tony, during a visit to the site. “Kissito will be working on saving lives physically, and we’ll be saving lives spiritually.”

In Uganda 83.9 percent of people consider themselves to be Christian, so there is always a need for churches.

The hospital grounds also have living quarters, where both missionary groups as well as health care groups will be able to stay when they come to visit.

Kissito is already working on revamping their health center, and in July of this year Pastor Tony and his group will be back to start the actual building of the health center!

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Road to recovery; every child matters

 UPDATE 9/3: After having severe stomach pain Brian was taken to the hospital again. It was found that he has an obstruction in his lower stomach that may have been caused by the poison. They were initially going to do surgery, but he started progressing, so they opted to see if he will get better without it first.  He will be in the hospital until at least Thursday. If he has made enough progress he will be discharged by the end of the week; if he is is unable to eat whole foods he will have to get surgery to remove the obstruction. 

You can help support Brian by donating at kissitointernational.org/donate.aspx and typing Brian in the Special Instructions box. All of the donations will go to his hospital bills and, hopefully soon, his school fees as well. 


Sitting on the couch, drinking a mango juice box, Brian is completely engulfed in the  cartoon show on the TV. No one knows for sure, but it might be the first time he has ever watched a television show and although he can’t understand most of the English words he seems to enjoy the characters – laughing when they laugh, staring with longing when they seem sad.  He speaks Luguiso, like the majority of children from the eastern Uganda region, though since he’s been at the KHI compound, he hasn’t spoke much at all.  He understands most hand gestures, and will respond with a nod of his head when you rub your tummy like you’re hungry, or pretend to tilt a cup up to your mouth.  He seems happy enough, although his true feelings remain a mystery for now. One thing is certain though, and that is the fact that he probably never imagined he would be where he is now, when less than a month ago he was on the brink of death.


It was a Saturday afternoon and Carolina Tovar, a KHI volunteer was working at the Bugobero health center when the police came in with a little boy. He was 11, but was so frail and malnourished, that at first glance he didn’t seem any older than 6. They said a boda driver had found him lying in the middle of the road, and took him to the police station a few miles away. When the police started asking the boy questions he was so sick he could barely talk. He told them that he was sure his mother had poisoned him. She gave him a mendazi, a staple breakfast food, and told him to stay put; she was going to the Kenyan border and would be back in a couple of hours – it had been days since then.

Brian in the hospital, about a week after he was found.

Brian in the hospital, about a week after he was found.

Often times if a father leaves his family, the mother cannot support the children on her own. When she meets a new man it’s a possibility that he will want his own children with her. Although, not acceptable in any culture, it is not uncommon to hear about a mother abandoning her children when tempted with the promise of a better life. Brian is one of those unfathomable statistics.

Christine, the head nurse at the hospital had been walking through the villages trying to find his home or even a distant relative that would be able to take care of him, or at the very least sign paperwork for him. She came back empty handed; not a single person knew who Brian’s family was.

A man from the church in the village, Mufumbo Alex, had never met Brian but decided to care for him while he was in the hospital. Weeks later you could still find him next to the bed.  He did not have a dollar to his name, nor a roof to sleep under; not a thing to offer Brian but company and love. He gave it unconditionally though, and that seemed to be enough.


The staff at Bugobero was able to stabalize him, but after about 24 hours they decided he would need an ultrasound. In order to get one he would need to take the two hour drive to the regional referral hospital. Carolina decided she could not let him stay there alone, and the KHI team decided together that we would bring him to the private hospital to make sure he had the best care, and if needed we would pay for the cost ourselves.

He spent two weeks in the hospital, and after numerous test and x-rays it was decided that he would need surgery in order for his stomach to heal. He was so brave the entire time, braver than any 11 year old should ever have to be.

Day by day you could see the strength come back into his body. Slowly but surely he was beginning to look like a happy young adult. He was able to sit up, and then walk on his own. Kissito volunteers were bringing him porridge at first, but is wasn’t long before he was able to eat rice and beans and chicken.

Before we knew it, it was time for him to be discharged…

… and go home.


We sat around the living room one night taking about the options for him when he left the hospital. He could stay at Bugobero for a while, but no kid (or adult even) would want to live at the hospital. He could sit at the police station until they find an orphanage for him, but he could be there for weeks or months, with no promise of food or his medicine. It didn’t take long before we realized what he had to do. When you have a house with empty rooms, and extra food every night, how could we not let him stay there?

So that’s exactly how it happened, and he’s been here almost two weeks now. He is still malnourished, and has a number of health problems, but he gets stronger every day. He is still a ways away from recovery, but is growing stronger every day.

Brian, about 2 weeks after being discharged from the hospital.

Brian, about 2 weeks after being discharged from the hospital.

We hope to find a family member, or someone in the village that knows him and will take him in for good. If not we will eventually find an orphanage that is good enough to provide for him; not just food and shelter, but education, guidance and compassion.

As much as we want him to, we know he can’t stay forever. It will be just as hard to let him go as it was to see him for the first time.  As hard as it’s going to be though, it will be worth it, knowing we changed his story, and saved his life.


We may not be able to save the world, but as the quote goes “Whoever saves one life saves the world entire,” and because of the compassion of Mufunbo Alex, the staff at the hospital, and the KHI team – Brian has the entire world ahead of him.

To stay up to date with Brians recovery visit us on Facebook and Twitter. Or, if you want to sponsor Brian, you can donate directly to him by simply typing Brian in the Special Interest box. All of the contributions will go to his hospital bills and his integration back into a normal life.

Ceremony for the Coalition Against Poverty


“I promise to perform my duties and uphold the integrity of the Mbale CAP,” said KHIs Honorable Wanjusi, while taking an oath at the swearing-in ceremony on Friday afternoon at the PONT offices in Mbale, Uganda.

The Mbale CAP is the Coalition Against Poverty; a new initiative to develop sustainable practices for community growth in the Mbale region. It is the first time that so many different stakeholders have been able to come and work together for one purpose.

According to their website, the “coalition works on a range of environmental, health, education and livelihood projects geared towards reduction of poverty amongst the communities of Mbale region.”

It is comprised of local government hospitals and schools, local and international NGOs, and universities in both Uganda and Wales.

“It has evolved because we’ve allowed international voices to be heard, but allowed Ugandans to really make the policy decisions,” said Jayne Brencher of PONT. “If we (the international stakeholders) pulled out today it would still be sustainable, and that’s truly the best part about this model.”

The CAP hopes to influence mutual policy changes – changes in the way NGOs operate in Mbale, and changes in the policies made by the local government.

“This position is a great honor, and a great challenge,” said Mr. Otim Ben, the DHO of Mbale, as he accepted his nomination as the Chairman of CAP. “I hope we can all remember that leadership is not about the position that you hold, it is about the service that you give.”

A few of the projects the CAP will be undertaking have already begun. Doctors in Whales are able to take a month off of work, with pay, to come to Mbale and work in the hospitals or lecture in the universities.  The biggest task the CAP has started however is the Wales-Mbale Climate Change Tree Planting (CCTP).

Climate change has been recognized as an issue in Uganda for years. Whales, with partners in Uganda took the issue up about 10 years ago and have been studying it ever since. Schools, like the University of Glamorgan in Wales, have been doing comprehensive research on climate change, such as measuring water supplies, and tracking deforestation.

The research started to come together and two years ago a plan was formed to make environmental policies a reality. Small initiatives have already been started – things like tree planting or bee keeping. The main goal though, was to combine the research and come up with a document that details a precise plan for environmental sustainability.  Finally, after two years of hard work, the model is finally ready for the implementation phase. The ceremony in Mbale is only a couple weeks away and and KHI, along with PONT are ready to see just how sustainable we can really make the Eastern Uganda region.

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Doctors dedicated to sustainable change

In the operating room at the local regional hospital Dr. Judy and Dr. Mark Gustafson worked side by side, on a mother who had just given birth to a baby girl. Dr. Judy, an anesthesiologist and Dr. Mark, a gynecologist were in the O.R. for about two hours with the mother and child. They spoke of the story with mixed emotions.

The mother had been in labor for hours, possibly surpassing a full day. When it was finally her turn in the operating room the lack of supplies almost delayed the delivery again. Luckily, Kissito has a supply stock, and Tyler, the supply chain coordinator, was able to retrieve some of the necessary items and bring them to the hospital.

Dr. Mark Gustasfon during a c-section at Mbale Regional Referral Hospital

Dr. Mark Gustasfon during a c-section at Mbale Regional Referral Hospital

They were able to do the delivery through a caesarean section, but the baby came out with the umbilical chord wrapped around his neck, and was not breathing. The operating room only had one oxygen mask and it was needed for both the baby and mother.

Dr. Judy kind of chuckled at the level of intensity her and her husband felt during that moment in the operating room. Mark was taking care of the mother while she was taking care of the newborn.

“I need the oxygen now!”

“NO! I need it now!,”  they urgently called out to each other, trying to make sure both patients were able to breathe.

After about ten minutes the nurse looked at Judy and the baby and said “I think now we pray”. Judy did not give up though, and a few minutes later the baby finally started breathing on its own.  Even after the surgery they could hear the baby in the next room. The nurses were shocked. “Can you hear it? The baby’s crying, the baby’s crying!” they exclaimed, joyful and astonished that the child had made it.


It was a completely different setting than the one you would find in Virginia, at the Carilion Roanoke Memorial Hospital where Judy practices, or the Lewis Gale Hospital where Mark is located.

In the U.S. facilities are spotless, sanitation is mandatory, medical supplies are always present, and protocols are followed with care and precision. Unfortunately, in East Africa, none of this is true.

The biggest disparity they noticed between U.S and the East African health facilities was the lack of training. Instead of intense schooling, most of the medical staff members receive on the job training.

According to Dr. Judy there are three main components that need to be addressed, in a particular order:

  • Training
  • Equipment and Supplies
  • Protocol

They are all intertwined, but the latter cannot work without the former.

Mark and Judy are being included in addressing these issues and are in the process of designing protocols and training programs for the healthcare workers.

Their first trip to Uganda only lasted two weeks, but they have already planned a return trip in April, to do more in-depth training , and to help put protocols in place!

Their education programs, along with all of the donations from their hospitals have the ability to single-handedly change a hospital, and possibly even a culture.

It’s not always easy to find doctors willing to stay in less than comfortable conditions, and work in less than practical environments. It’s even harder to find doctors willing to come back time and time again.

Drs. Judy and Mark however, are a rare gem and we are so glad to have them as part of the KHI team. Knowledge is truly the most important donation you can give, and we are incredibly grateful for their dedication to the sustainability of the education given to the people in Eastern Uganda!

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MDG 5a: An Update on Maternal Mortality

Article attribution to Mike Miesen, a volunteer in Uganda who is working with the Kissito Healthcare International initiative to reduce maternal mortality at the Mbale Regional Referral Hospital.

Let’s just get this out of the way: With two years left, it is highly unlikely that Millennium Development Goal (MDG) 5a – in the clunky verbiage of the UN: “Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio” – will be met worldwide.

But substantial progress has been made, which, in human terms, means that hundreds of thousands of maternal deaths have been prevented. It’s worth taking a step back to understand the scope and scale of the problem, and to think through the interventions that have been successful in myriad developing and developed countries.

The Maternal Mortality Ratio (MMR) is calculated as the number of pregnancy-related deaths (from any point in the pregnancy to 42 days post-birth/termination) per 100,000 live births. In 2010, an estimated 287,000 mothers died from pregnancy-related causes, or 210 deaths per 100,000 live births; it’s an almost 50 percent reduction from 1990, when an estimated 543,000 mothers died, or 400 per 100,000 live births.

These roll-up figures mask a wide variation in the distribution of maternal mortality; in 2010, an astounding 99% of deaths occurred in the developing world (56% in sub-Saharan Africa alone), and the MMR in developing countries is, on average, 15 times higher than in developed countries. According to the World Bank, the country with the highest MMR in 2010 was Chad, the lowest Estonia, at 1,100 and 2 per 100,000 live births, respectively. A chart showing the 40 countries with the highest MMR is below, with the United States – at 21 – added for reference:


Scan the list of countries and it becomes clear that the MMR problem is clustered in Africa, with few exceptions; there’s wide variation among developing countries, too. The question is: why?

Worldwide, the leading direct causes of maternal mortality are Post-Partum Haemorrhage (PPH); Pre-eclampsia and eclampsia; and sepsis (see Figure X). Together, these three conditions account for 60% of maternal deaths. At the patient-level, interventions to prevent or treat all three are well-understood, cheap, and straightforward:


  • Prevention of PPH is facilitated by following a protocol known as Active Management of the Third Stage of Labor (AMTSL), which involves the administration of an uterotonic (e.g., oxytocin, ergometrine, misoprostol) and massaging/monitoring for two hours post-birth. A Randomized Controlled Trial (RCT) found that women who received AMTSL experienced PPH 6.8% of the time vs. 16.5% with passive/conservative management – almost a 60% decrease
  • Treatment of pre-eclampsia and eclampsia involves the injection of magnesium sulphate, a cheap compound (in the West, the non-pharmaceutical preparation is known as Epsom salt). A highly-regarded RCT found that magnesium sulphate halves the risk of eclampsia in pregnant women
  • Prevention of puerperal fever*, or sepsis more generally, is a matter of maintaining proper sanitation before, during, and after a birth. If a mother develops sepsis, a full course of antibiotics can be administered as treatment

Here’s what’s clear: the devil isn’t in the details – it’s in the diffusion of pharmaceuticals, health care workers, and knowledge through health systems, and in improving those systems holistically. It goes deeper than the health system, of course; to administer AMTSL, for example, requires the drug being available (partially a supply chain/regulation issue), a health care worker who is trained to administer the drug (an education issue), and a health care worker who has the time to administer the massage every 15 minutes for two hours (a financing issue). And keep in mind: that’s only if the mother has a trained health care worker by her side, which in sub-Saharan Africa puts her in the minority, with only about 46% of births attended by skilled health personnel in 2008.

The complex task of reducing maternal mortality demands a multifactorial solution that draws on a wide coalition of government departments and private organizations – and each country has to find a solution that meshes with its own cultural and structural realities. Nevertheless, there are broad themes that transcend these inter-country differences and show up in the success stories of many positive deviants:

  • Increase access to family planning and contraception
  • Strengthen demand for antenatal check-ins through education campaigns, conditional cash transfer programmes, or easier access to skilled professionals
  • Increase the percentage of births attended to by a skilled professional; ensure skilled professional is able to provide necessary care (e.g., equipment, pharmaceuticals, knowledge) for non-complicated birth and is able to refer complicated cases
  • Ensure Emergency Obstetric and Neonatal Care (EmONC) services are comprehensive and of high quality, and that health centres are staffed with skilled workers; stocked with maternal medicines, antibiotics, and proper equipment; and accessible to remote populations
  • Establish or strengthen monitoring systems to highlight successes and areas of opportunity

All of which goes a long way towards our understanding of why some countries have already reached MDG 5a and others are unlikely to do so: the interventions require sustained political will, ‘soft’ infrastructure (e.g., regulations, communication), consistent funding, and a systems approach to process improvement. Unfortunately, it may take more than 20 or 25 years to build out this basic scaffolding on which to build sustainable change.

The imminent failure to reach the goal of reducing the MMR by 75% by 2015 shouldn’t obscure the fact that there are hundreds of thousands of mothers alive who, without the focus on maternal mortality, may not be otherwise. Much more can – and will – be done in the next two years, and in the next two decades.

In many ways, 2015 is just the start.


*If you’re a public health or history of medicine wonk, you may recall that puerperal fever (or childbed fever, as it was known) was the disease that led Ignaz Semmelweis to call for basic hygiene measures in his Viennese hospital pre-Germ Theory of Disease – and was promptly rejected from the establishment for his heresy. As one contemporary doctor put it, “Doctors are gentlemen, and gentlemen’s hands are clean.”