Montefiore Einstein and Doctors for Global Health in Uganda

Kisoro Hospital, Uganda

Dr. Laurie Jacobs, Interim Chair of the Department of Medicine, recently visited Montefiore Einstein's Global Health Program in Uganda. Since 2005, Einstein faculty, residents and medical students have joined with Doctors for Global Health and Montefiore Health System to staff Kisoro District Hospital (KDH) in southwestern Uganda, a largely rural area north of Rwanda and east of the Congo. Each year, approximately 20 residents and 16 medical students travel to Kisoro to serve one-month rotations on the KDH medical wards and run clinics. Supervision is provided by a faculty member from the Global Health and Clinical Skills Faculty Development Fellowship (GHACS).

The program serves a high-needs population—the average Kisoro family subsists on a per capita income of $2/day; women commonly have eight children; and doctors are paid $3,800 per year. Kisoro’s doctor-to-population ratio is one to 40,000+, and KDH is understaffed at every level: 1-3 young physicians (the hospital is funded for six) are responsible for over 150 inpatient beds and clinics with 150-200 patient visits/day; nursing is staffed at 60% capacity; and the lab, though funded for four, has two technicians.

From left: Dr. Gloria Fung Chaw, Dr. Laurie Jacobs, and Ugandan colleague Sam Musominali

Under the strong leadership of Dr. Gerald Paccione, Professor of Clinical Medicine at Einstein and Director of Global for the Primary Care and Social Internal Medicine Residency Program, the program has gained a national reputation in the U.S. for excellence in global health training and service delivery. 

Dr. Jacobs spent the week making rounds with clinician educator Dr. Gloria Fung Chaw and residents Dr. Radeyah Hack and Dr. Gaurav Rao, as well as community and home visits with Einstein student Faraz Alizadeh, who is working in the program for the year. 

"The experience reinforced my pride in the commitment of Montefiore physicians in caring for all, as well as my bedside skills!" Dr. Jacobs said.

The program’s hospital and community outreach projects, which have grown exponentially over the past ten years, span a wide range of needs:

• Two-year GHACS (Global Health and Clinical Skills) Faculty Development Fellowship
• Chronic Care Clinic (CCC), which operates 2 days/week and serves over 1000 patients
• Psychiatry services for Uganda’s enormous burden of untreated depression, schizophrenia, and post-traumatic stress disorder
• HIV Clinic
• Cardiac and Referral Project (rheumatic heart disease claims the lives of over 250,000 Africans annually)

From left: Dr. Jacobs, Dr. Fung Chaw, Faraz Alizadeh, Dr. Radeyah Hack, and Dr. Gaurav Rao
• Scholarships for high-school-age orphans and prior DGH/KDH employees who are now enrolled in schools of medicine, nursing, development, and social work
• Village Health Worker (VHW) Program, which addresses Kisoro’s significant child and maternal mortality rates by bringing primary and preventive health care to remote communities through trained village laymen (mostly farmers)
• Malnutrition Program’s inpatient malnutrition unit and community-based nutrition program rehabilitate approximately 400-800 children annually. This program has been recognized as one of the most effective nutrition programs in Uganda by the Uganda Parliament, and has been recognized as national model for malnutrition programs.
• Chronic Disease in the Community (CDCom) Project, which cares for nearly 300 villagers with chronic disease, saving them the arduous and/or costly trip to the KDH clinic
• Follow-up Project: a team of trained staff reaches out by motorcycle to remote villagers with diseases like tuberculosis, heart failure, diabetes, HIV, and cervical cancer, who need continuous care but have stopped coming to the clinic
• "Transport-Plus Insurance Program" (TPIP), a “social enterprise” to improve access to care, charging families $8/year for markedly discounted cab transportation to the hospital and direct consultation. The program’s modest profit is used to support the VHW Program (i.e. salaries and training).
• Microfinance no-interest loans for TPIP members
• Students-in-the-Community Project (SICP), in which four groups of Einstein medical students work in Kisoro "short term" for 2 months in the summer, fall, and spring. Students have been instrumental in creating the program’s women’s health projects, malnutrition program, CCC, etc.
• Women’s Health
• Cervical Cancer Screening, for which Einstein medical student Chavi Kahn and Eleanor Chung were awarded the Lancet Award for Global Community Service in 2010
• Women’s Clinic and Women’s Day Community Outreaches
• Maternal Mortality Project and Midwife Education (CME)
• Ante-Natal Care (ANC) Project, offering pregnant women modest cash incentives for adhering to prenatal visits
• Women’s Groups to raise awareness of and mobilize women around gender inequality and extend the work of the VHWs by empowering women interested in health
• Weekly call-in radio program broadcast district-wide and devoted to women’s health