ANNUAL REPORT 2009/2010 - Interplast Holland · ANNUAL REPORT 2009/2010 . ... Makerere University dept of Pharmacy building and Mulago Hospital main theatre ... unit in Mulago, Kampala

UGANDA BURNS AND PLASTIC AND SURGERY INSTITUTE

(UBPSI)

ANNUAL REPORT 2009/2010

Annual Report July 2009 – June 2010 2

Table of Contents

1. WORD FROM THE CHAIRMAN

2. WORD FROM THE HEAD OF UNIT

3. INTRODUCTION

4. REPORT BY MS ANNEMARIE MAAS

5. REPORT BY TERN VAN ALPHEN

6. ACTIVITIES

i. Patient Care statistics

ii. Burns Awareness

iii. Staff Annual Retreat

iv. Other activities


WORD FROM THE CHAIRMAN BOARD OF DIRECTORS

Over the years our Burns Unit at the Mulago University Referral

Hospital is performing better and better.

We greatly miss the late Father Albert Byaruhanga one of the

founders and first Chairman of UBPSI and the driving force

behind its success.

We thank him for his leadership and we will continue the path he

laid out for us.

The number of patients are increasing and are managed by a

team that is up to its task.

We greatly thank our greatest supporters the Stichting Interplast Holland, not only

for their financial contributions but as well for their technical assistance both medical

and organizational.

Our goal is to improve even more on our present way of working and to launch a

long term sustainable prevention programme.

On behalf of our Patron the first lady Mrs. Janet K. Museveni, our patients, the

employees at the Burns Unit and the members of the board I would like to full

heartedly thank you for your valuable support in the past and in the future.

Dirk ten Brink

Chairman,

Board of Directors,

Uganda Burns and Plastic Surgery Institute


WORD FROM THE HEAD OF UNIT DR ROBERT SSENTONGO


INTRODUCTION

We are glad to have completed yet another year and this report is a brief outline of the

activities of the Uganda Burns and Plastic Surgery Institute (UBPSI)

Special thanks go to Stichting Interplast Holland who have continued to support the UBPSI

through fundraising training and technical collaboration. There have been several visits from

staff of Interplast Holland led Dr Rein Zeeman and Ms Marjo Aerts and these have been in

incredible boost to the activities of the institute in terms of training and knowledge transfer

both on the medical and administration.

Also during this period Ms Annemarie Maas the office Manager of Interplast Holland was able

to visit the Institute and the patients for the first time to see what has been happening all the

time which she only used to see in reports and pictures.

She also came with Mr Joris Jan Kruegel a free lance journalist and photographer.

Mr Peter Joris was able to capture our activities on film and camera for awareness and for

fundraising purposes. This would help us highlight our activities both locally and on the

international scene. Ms Annemarie was kind enough to write a brief report about her visit and

impression of the activities of the UBPSI.

We also had a visiting student from the Netherlands Mr Tert van Alphen who is a third year

medical student. He spent 4 weeks in the country two of which he spent in Kitgum with the IPH

tem which was doing work on war victims in partnership with the International Criminal court

under the stewardship of Dr Rein Zeeman. The other two weeks he spent working on the burns

Unit and also part of the team that was starting the Burns community programme led by Dr

Zeeman and Ms Marjo Aerts.He was also kind enough to come up with a report of his visit.

UBPSI staff also during this time went on another retreat at Ssese islands from the 4th

to 7th

Dec

2009 and a brief report is herein included.

UBPSI continued to partner with other organization like Smile Train. This was especially in

treatment of cleft lip and palate patients all over the country. Dr Robert Ssentongo was

facilitated by Smile train to go around the district hospitals of Iganga, Buluba, Masaka and

Kalisizo operating on these patients.

Also between the 24th

and 30th

May 2009, we held a Smile train workshop and surgical camp at

Makerere University dept of Pharmacy building and Mulago Hospital main theatre respectively.

It was also with the collaboration of a team from the Great Ormond street children hospital and

North Thames Hospital. The team led by Dr Brian Sommerland also included Ms Walker

Isabeau, Mrs Julie Hughes, and Mrs. Marie Pinkstone.This was a great success we hope this

collaboration will continue.

Uganda Burns and Plastic Surgery Institute supported Interplast Holland in the collaboration

with the Trust Fund for the International Criminal court to Kitgum in the North of Uganda.

The Plastic surgery camp operated on 67 patients and it was for two weeks from 6th

to the 17th

June 2010. The team that was led by Dr Rein Zeeman included Mr Floris de Graaf, Ms Henriette

Willenger, Michael Angel Longolyang and Tert van Alphen.

After the IPH/ICC trip Dr Zeeman together with Ms Marjo Aerts stayed at the UBPSI stayed on

for another 5 weeks to support the activities of the Burns Unit.

The visit also was aimed at starting a Burns Prevention program, looking for a start for an

Amnion Bank introduce a new unique mesh graft technique and observe the running and

progress of the Burns Unit.


Report by Ms Annemarie Maas, Office Manager Interplast Holland

Ever since I started working with Interplast

Holland (early 2004) everything was

centered around setting up and opening

the first specialized Burns Unit in Uganda.

Little did I know at the time about Uganda

or Africa in general. Over the years I got to

know Mulago Hospital and Kampala well

but what I learned came from reports,

stories and a lot of pictures! So it was very

exciting to go and visit Uganda myself in

November 2009. The goals of this visit

were; to visit the Burns Unit and her staff,

to support Financial Manager Stephen

Cato and to shoot a film about the work at

the Burns Unit together with journalist and

cameraman Joris Kreugel.

What impressed me most is how dedicated the nurses and other members of staff are to their

patients and how proud they are of what they do. And they do make a difference! The work is

often very difficult because a lot of children whom are badly burned still die or if they survive they

need intensive care for sometimes months! But thanks to the care and dedication of the staff a lot

of children now do survive and do so without being handicapped for the rest of their lives. There is

still a lot to do and improve but the Unit is working and the knowledge is there and is shared

throughout the rest of the country.

For me personally this visit was the highlight of my seven years with Interplast Holland and I hope it

doesn’t take another seven to come back!


My Internship by Tert van Alphen

It’s hard for me to put all my experiences on a

little piece of paper. I went to Uganda for a

short internship of 4 weeks working at burns

unit in Mulago, Kampala. After my arrival Dr.

Rein Zeeman asked me to join him and his team

on a trip up north. So my program changed and

went 2 week up North to Kitgum and then back

for 2 weeks in Mulago. I was very excited to go

and actually see patients and help the team

were I can. I’m a third year medical student (of

the six) so my experience outside the study

books is still very little and this has been a great

opportunity to really see and experience all this from the front.

After a long journey up north we arrived in Kitgum and the next day we started the screening. As

we screened about 60 patients on the first day I thought, how are we going to manage that? There

were so many patients and the conditions were very basic. For example the first day’s airco didn’t

work so it was very, very hot. The Dutch team that went to Kitgum was very motivated and wanted

to operate patient after patient. And although the locals medical staff weren’t used to our high

speed working system, they did their best. They all enjoyed their work and we had a lot of fun

together. Between the screenings, operations and ward rounds there was time to relax while

drinking thee, having lunch and after work watch the world championship of football! After

working 8 days we helped a lot of people and now it’s the task of the local medical staff to make

our journey a success. Because we operated on a lot of feet and hands, almost every patient needs

physiotherapy and a lot of training. Hope that they can manage all these patients!

Back in Kampala it was a different story. In the north it was mostly mutilated faces and

contractures of feet and hands. In the burns unit in Mulago there are mostly patient with fresh

burns of 3 months ago till yesterday. I mostly worked with Charles from the ward to wash these

patients. The bathing was sometimes painful for the patients so that was a new experience for me.

It was hard to see some of those awful burn wounds of fire/hot liquid and acid. I have also been to

theater in Mulago which was almost the same as in Kitgum. After the patient is a sleep you don’t

see a patient, you only see the wounds and your goal. In my stay in Uganda an interviewed a lot of

patients about their background. What the reasons were of their mutilated faces and burned

bodies. The stories of these people were amazing and mostly shocking. I will never forget the

stories and the faces, it was a wonderful experience in Uganda. Thank you Interplast Holland and.

Keep up the good work!!


ACTIVITIES

The UBPSI continued with the mission of improving on the care of burns patients, performing

Plastic Surgery, creating awareness about prevention and treatment of burns and training medical

staff and paramedics in these fields. of UBPSI.

Through out the year we saw and admitted patients at the burns unit and the statistics that give a

picture of what we were able to achieve throughout the year.

With the completion of the renovations of the ICU we were able to admit and care for more

severely burnt patients than the previous year.

We also registered an increased number of patients who were presented for both admission and

treatment. This we think is because after all these years more and more people know about the

Burns Unit and therefore there are more referrals. With the increase in number of patients there

was an inevitable increase in work load and the staff of the UBPSI should be commended for taking

increased workload in step and continuing to do an incredibly good job at whatever they are doing.

Also from the statistics we see an increased number of cleft lip and palate patients especially from

our collaboration with Smile train.

1. Burns ICU

Numbers of

patients

2006-2007

(July-July)

Numbers

of

patients

2007-2008

(July-July)

Numbers of

patients

2008-2009

(July –July)

Numbers

of

patients

2009-2010

(July-July)

Admissions of Burn

Patients

104 93 46

(Due to closure

of ICU)

107

Male 49% 52% 54% 54%

Female 51% 48% 46% 46%

Transferred Patients 24 39 9

29

Discharged Patients 18 4 4 20

Patients ran away 3 0 2

Patients died 62 47 26 43 (= 40%)


Number of Days at the

Ward Totally

1440 of 90

patients

972 of 89

patients

574 of 42

patients

(4 patients

unknown)

850 of 91

patients

(16

patients

unknown)

Average ‘days of stay’ at the Burns ICU of 90 patients is per patient: 9.3 days

(In 2008-2009 July-July this was 12.5 days)

16 Patients the number of days is unknown, so we count for this 16 x 9.3 = 149 days

Total number of days: 850 + 149 = 999 days

This means the average of patients per day at the ICU: 999/365 = 2.7 patients/day

Year 2006-2007

July-July

2007-2008

July-July

2008-2009

July-July

2009-2010

July-July

Patients per day 2.8 3.4 2.7

< 30% TBSA burned: 44 patients 43.5%

30 – 60% TBSA burned: 36 patients 35.5%

>60% TBSA burned: 22 patients 21%

TBSA = Total Body Surface Area

Number of children < 5 years old: 52 patients

Number of children 5 – 12 years old: 11 patients

Flame Burns: 53 patients: 43% female 57% male

(4 inhalation traumas are mentioned)

Hot fluids: 42 patients: 52% female 48% male

Acid: 10 patients: 30% female 70% male

Electricity: 1 patient: 0% female 100% male

Others (not burns): 2 patients: 0% female 100% male


2. Holland Ward

Numbers

of

patients

2007

(Feb-July)

Numbers

of

patients

2007-2008

(July-July)

Numbers of

patients

2008-2009

(July – July)

Numbers

of

patients

2009-2010

(July-July)

Notes

Admissions of

Burn Patients

142 318 360

(Renovation

exercise at ICU.

Patients were

admitted at

HW).

400

Patients admitted already

before the 1st

of July 2009

16

Female 62 141 165 180

Male 80 177 195 220

Transferred Patients 9 8 1 2 to ICU

2 to

others

Discharged Patients 121 290 224

(No indication

for what

happened to 50

patients)

297

Patients run away 6 19 25 18

Patients died 6 9 60 16

Patients who are still there

or not recorded

77

Number of Days at the Ward

Totally

2,185 of

125

patients

5,228 of

246

patients

6,312 of 298

patients

(In 2008-2009,

62 patients

unknown)

6,931 of

336

patients

(In 2009-

2010, 80

patients

unknown)


Average ‘days of stay’ at Holland Ward of 336 patients is: 20.6 days/patient

(In 2008-2009 July-July this was 21.2 days)

We count for 80 patients whose ‘days of stay’ is unknown: 80 x 20.6 = 1,650 days

Total number of days of all patients: 6,931 + 1,650 = 8,581 days

The average of patients per day at Holland Ward is: 8,581/365 = 23.5 patients/day

Year 2006-2007

July-July

2007-2008

July-July

2008-2009

July-July

2009-2010

July-July

Patients per day 18 21 23.5

< 10% burned: 105 patients 28.5%

10-20% burned: 163 patients 43.5%

20 – 30% TBSA burned: 70 patients 18.5%

30-60% burned: 35 patients 9%

> 60% TBSA burned: 1 patient 0.2%

TBSA = Total Body Surface Area

Conclusion:

The number ‘days of stay’ is less comparing to the year before, but the TBSA burned is smaller than

before. There are about 100 patients who had a TBSA burned less than 10%. The number of

patients who had a TBSA burned in between 20 and 60% is less than before, and also more than

60% burned is only 1 patient (the year before 12 patients).

Acid Burns: 12 patients: 50% female, 50% male

Flame Burns: 80 patients: 56% female, 44% male

Hot Fluids: 278 patients: 52% female, 48% male

Electricity: 8 patients: 0% female, 100% male

Others: 22 patients: 54% female, 46% male

Unknown: 29

Epileptic: 10 patients were counted (this determinant is not recorded very well)

Number of patients < 5 years old: 226 patients (182 by hot fluids 29 by flame)

Number of patients 5-14 years old: 47 patients (72 by hot fluids 13 by flame)

Number of patients > 14 years old: 151 patients (24 by hot fluids 41 by flame)


3. ITIES Burns Theatre

Number

operations

2006-2007

(July-July)

Number

operations

2007-2008

(July-July)

Number

operations

2008-2009

(July – July)

Number

operations

2008-2009

(July-July)

Total of operations 356 189 213 312

Split Skin Grafting 41% 44% 25.4% 38%

Changing Dressings 20.5% 19.5% 13% 20.5%

Cleft Lip or Palate 8%

Hernia Repair 0.65%

Others 38.5% 36.5% 61% 33%

Days of Operations 105 91 94 136

From the 1st

of July 2009 – the 30th

of June 2010 the average of operations per day is: 2.3

patients/day

In 2008-2009 (July-June) this was 2.3 patients /day.

4. Main Theatre

Number operations

2009-2010 (July-

July)

Notes

Total of operations 146

Cleft lip or palate repair 33

Split Skin Grafting 9

Post Burn Contractures 25

Kelli 7

Others 72

Days of Operations 60 2.4 patients per session

The patients from ward 3BP (plastic surgery ward), who were operated in Main Theatre, are

recorded for the first time from July 2009 till July 2010.


5. Plastic and Reconstructive Ward (3BP)

Numbers

of patients

2006-2007

(July-July)

Numbers

of patients

2007-2008

(July-July)

Numbers

of patients

2008 -2009

(July – July)

Numbers

of patients

2009-2010

(July-July)

Admissions 182 154 210 218

Female 47% 54% 49% 51%

Male 53% 46% 51% 49%

Transferred 0 ? 2 2

Discharged 182 ? 169 144

Patients died 0 ? 1 3

Number of

days at the

Ward Totally

1168 of 84

patients

? 1952 of

172

Patients

( from 38

patients

unknown)

1356 of

148

(from 70

patients

unknown)

Average of days at 3BP of 148 patients is per patient: 1356/148 = 9.2 days

The number of days for 38 patients is unknown. We count these 70 x 9.2 = 644 days

Total number of days: 1356 + 644 = 2000 days

Per day there were on average 2000/365 = 5.5 patients

Year 2006-2007

July-July

2007-2008

July-July

2008-2009

July-July

2009-2010

July-July

Patients per day 6.5 5.5

Admission Diagnosis at the Plastic and reconstructive Ward 3BP:

- Post Burn Contractures: 49 patients 22.5%

- Burns 27 patients 12%

- Cleft lip and/or palate 35 patients 16%

- Ulcers 11 patients 5%

- Kelli 6 patients 3.5%

- Others / unknown 90 patients 41%

The number of daily dressings at 3BP was from July 2009 till July 2010

(Outpatients and emergency ward): 1899 patients in 235 days

Note: From November and December 2009 there are no records.


6. The Surgical Out-Patient Clinic

The Surgical Outpatient Clinic is a once a week clinic. Every Monday the plastic surgeons see their

patients with plastic, reconstructive, and (post) burn problems. Nurses of 3B Plastic assist in the

dressing of these patients or patients are going to Holland Ward for dressing. This year the

outpatients at ward 3BP are not recorded separately.

From 1st

July 2009 – 31st

June 2010, 438 patients were attended to in 44 days.

This is about 10 patients per session.

Burns awareness campaign

Uganda Burns and Plastic Surgery Institute (UBPSI) in conjunction with Interplast Holland

successfully held the third annual Burns Awareness Week (BAW) under the theme ‘Stop Burns. Get

Involved’ which was aimed getting more people within the community involved in preventing burns

occurrences within the community and in instances where burns occur, to ensure that patients get

the right treatment on time.

The Burns Awareness week was launched on November 7th

2009 and it took place between

November 14th

to 20th

2009.

The 2009 BAW maintained the previous year’s theme ‘Stop Burns. Get involved’, because it is

important that more and more members of the community get involved in preventing and treating

burns. These members of the community range from the individual citizens, corporate

organizations, business community, corporate organizations, and government parastatals among

others.


Besides this, statistics show that UBPSI receives approximately 1,100 patients on an annual basis.

Out of these, 60% of burns happen in the home and are preventable. They are normally caused by

hot (boiling) fluids, unstable cooking places or unstable candles in houses.

BURNS AWARENESS WEEK 2009 ACTIVITIES

The third Burns Awareness Week (BAW) was mainly focused on sending out the burns treatment

and prevention message to the high risk groups namely;

• Slums dwellers

� Children and Women

� Heads of Households

� Opinion leaders

To reach these different audiences, the BAW was broken down into 3 main activities namely:

• Burns Sensitization Camp

• Burns Awareness Walk

• Burns Health Workers Symposium

Burns Sensitization camp

The Burns sensitization camp which received over 100 patients was held in Bwaise, a local highly

populated slum in Kampala because it is in such places that burns are most likely to happen. During

this camp, several activities took place to include; diagnosing burns patients, giving the patients

and participants tips on burns prevention & treatment, giving talks on safe cooking methods, the

Uganda Police fire department giving live demonstrations on fire prevention and how to use a fire

extinguisher and fire blanket among others.

This activity was proposed mainly to target parents of children in vulnerable areas such as Bwaise

and Kawempe, reason it was held in a market place which is the source of living of most of the slum

dwellers in the area.

The UBPSI held a clinic in which all patients that had suffered from burns were either treated or

referred to Mulago hospital for further treatment.

After the talks, there was a question and answer session in which participants were rewarded with

stable sigiris, safe lanterns, safety blankets and fire helmets. Brochures and other relevant reading

materials such as newspaper inserts were also given out.

Being the pilot burns sensitization camp, there was a good turn up of patients as well as

participants which meant that there is an urge amongst people to know about burns prevention

and treatment. The local leaders within Bwaise area were very supportive especially the Women

LCI Chairman. The LC I chairman gave a speech that cautioned fellow Bwaise dwellers about burns.

The live demonstrations of methods of preventing burns i.e. safe cooking methods, how to use a

fire extinguisher, how to use a fire blanket among others was key in ensuring that the participants

clearly understood.


Burns Sensitization camp

The Burns sensitization camp which received over 100

patients was held in Bwaise, a local highly populated slum in

Kampala because it is in such places that burns are most

likely to happen. During this camp, several activities took

place to include; diagnosing burns patients, giving the

patients and participants tips on burns prevention &

treatment, giving talks on safe cooking methods, the Uganda

Police fire department giving live demonstrations on fire

prevention and how to use a fire extinguisher and fire

blanket among others.

This activity was proposed mainly to target parents of

children in vulnerable areas such as Bwaise and Kawempe,

reason it was held in a market place which is the source of

living of most of the slum dwellers in the area.

The UBPSI held a clinic in which all patients that had suffered

from burns were either treated or referred to Mulago

hospital for further treatment.

After the talks, there was a question and answer session in

which participants were rewarded with stable sigiris, safe

lanterns, safety blankets and fire helmets. Brochures and

other relevant reading materials such as newspaper inserts

were also given out.

Being the pilot burns sensitization camp, there was a good

turn up of patients as well as participants which meant that

there is an urge amongst people to know about burns

prevention and treatment. The local leaders within Bwaise

area were very supportive especially the Women LCI

Chairman. The LC I chairman gave a speech that cautioned

fellow Bwaise dwellers about burns. The live demonstrations

of methods of preventing burns i.e. safe cooking methods, how to use a fire extinguisher, how to

use a fire blanket among others was key in ensuring that the participants clearly understood.

Daily Monitor dated 10th Nov 2009 page 8


Burns Awareness walk

The Burns Awareness walk held on November 14th

was aimed at creating awareness amongst the

general public on treatment and prevention of burns. During the walk, several reading material on

burns were handed out to the general public as a sensitization exercise. The walk started off from

Mulago hospital, through Kamwokya – Kifumbira zone Kalerwe market, to Wandegeya Katanga

Zone and eventually ending at Mulago Hospital.

The choice of areas to have the walk in was based on the fact that most of the patients at UBPSI

mainly come out from very congested areas like these.

A number of schools, UBPSI staff members, members of the press and well wishers participated in

the walk. Most of the slum dwellers joined the walk and eagerly took the brochures on burns

prevention which were on hand.

Positive Outcome

• Since Awareness walk went through the slums of Kifumbira, Kalerwe and Katanga, reading

materials on burns prevention and treatment were handed out to the slum dwellers.

• The Prisons band on board also showed government backing for the campaign

• The walk also gave the participants a chance to have fun and exercise.

• Immediate electronic media coverage.


Burns Awareness Walk in Pictures

Walkers enjoying refreshments after the walk.

Burns Awareness Attire


Burns Health Workers

The Burns Health Workers Symposium which was held on 20th

November 2009 was the culmination

of the B A awareness week which was launched on the 7th November. It was primarily aimed at

ensuring that the medical practitioners countrywide are up to date with all the ways of preventing

and treating burns. Over 150 medical workers countrywide turned up to take part in this

Symposium during which they were trained, presentations made & reading materials on burns

treatment & prevention handed out. In addition to equipping health workers with information,

there was a presentation on customer care. The aim was to make workers more sensitive to

patients’ needs at more than just the treatment level but right from the time the patient registers

at the hospital until they leave.

The Medical staff attending the Health Workers Symposium.


1. The Staff’s annual retreat

The Uganda Burns and Plastic Surgery Institute annual staff retreat was held from the 4th to 7th

December 2009.

We left Mulago Hospital at 9 Am by a hired Minibus and got to Entebbe (Nakiwogo) at 10: 30 Am.

At Nakiwogo we had the arrangement procedures for the journey across to Kalangala Island. We

left Nakiwogo for Kalangala at 2 Pm and reached Kalangala at 5:25 Pm.

On arrival, we were ushered in the Panorama Resort Beach and then served with evening tea.

Cottages were then allocated (3 per cottage). We had supper, refreshments and then went to rest

at leisure.

The following day 5th

December, after a heavy breakfast, we had an evaluation session for the year

2009. The following areas were explored: Nursing, training, surgery, dispensing, couselling &

Guidance, nutrition, Finance & Administration, Therapies, Anesthesia & Pain control and support

functions.

Afternoons and evenings were reserved for leisure activities and sports like swimming and beach

volleyball.

In the evenings the staff sat around the fire place for socializing meals and drinks and they retired

at leisure to their cottages.

The retreat actually met its objectives of evaluation and relaxation away from the work

environment. There is a full report available from this staff retreat with the administrator office.


Group Photo after the staff retreat

Returning from Kalangala, Ssese Islands

Other Activities

The Unit continued to hold monthly staff meetings every first Wednesday of the month after the

Major Ward Round in the view of evaluating and determining future action for the improvement of

patient care.

In addition to these management introduced weekly management meetings every Monday

morning and these were mainly for top management of the unit. They were aimed at bringing

together both unit heads and administration at the beginning of the week to plan and coordinate

daily and weekly activities of the unit. These meetings were also aimed at addressing outstanding

issues on a weekly basis and on a management level

During both meetings, a review of the previous minutes is made and a thorough scrutiny to check

whether the action points were fulfilled is also made.

The Sisters in charge of the wards present an evaluation of the week ending and all members

endeavor to look at ways of improving on the patients’ care in the proceeding.


The board also continued to hold their board meetings and during this period the board met 6

times during the course of this year. We heard some fruitful deliberations and the minutes are with

the administration office.

Lastly we would once again to thank the staff of UBPSI for the very good work taking care of our

patients.

The board chairman and the members for the leadership and motivation and to all the

stakeholders/partners of UBPSI for making it possible and providing us with a platform to do what

we do.

Thank you all very much


Documents

ANNUAL REPORT 2009/2010 - Interplast Holland · ANNUAL REPORT 2009/2010 . ... Makerere University dept of Pharmacy building and Mulago Hospital main theatre ... unit in Mulago, Kampala