From the field: St. Claret Health Centre, Nyabwina, Mbarara Region, Uganda 2023

Written by: Simon Walley, Executive Director, MaterCare International, November, 2023

We visited St. Claret Maternity Centre which was the “Old School” compound. Our last visit was just prior to Covid in February 2020 and at the time, the maternity unit was in an old cramped, dimly lit building near the Sister’s old residence. The sisters did well to renovate the “old school” to provide a basic maternity unit with waiting room, examining room, delivery room, and postnatal ward.

The number of pregnant mothers that visit the centre for checkup during their pregnancy as well as the number of deliveries have increased since they moved to this centre. The mothers are more comfortable with this centre. The sisters organized many expectant mothers from the region to meet with MaterCare’s visiting team. Many of them traveled over 3 ½ hour walk one way to be there. Some from regions beyond Nyabwina. Their main concern was lack of ultrasound and costs of transport to St. Claret maternity centre and onto the nearest hospital if further care was required.

St. Claret Health Centre which is located next door to the Sisters of St. Joseph Convent compound. The centre is surrounded by a high secure wall. The main entrance is located on the side of the compound which is an ideal location. From the current building, there is an approximate 3ft wall that steps up to the land that slopes up to the top of the compound. The location of the proposed maternity unit is in the ideal spot. There is plenty of room and still provides space for further development in the future. From the top of the retaining wall, the land has a slight incline for about 60 ft which increases to about 30 degree as you near the top.

Changing the main entrance to the top of the compound would not be ideal. The main access road is narrow and would increase water flow onto the compound during rainy season. The present car park should be reduced for drop off only or moved outside the main entrance as is done in other health centres. The only vehicles that should be permited inside the compound should be the ambulance, boda boda (motorcycle taxi) for drop off of expectant mother or doctors vehicles.

We visited several schools and sites of outpatient clinics, which are currently old churches that lack any furniture. Sisters are given permission to use the churches when not in use by the congregation. We visited the village of Katunga, which is about 13kms away, but the road is sometimes nearly impassible. We barely made it there in 4×4 ambulance. I cannot imagine a pregnant mother walking these roads this distance to get proper care, especially during rainy season.

Once the new maternity health centre is constructed, it is our view that the maternity unit will be very busy. Funding the ultrasound machine will also generate income and help make mothers’ pregnancies much easier and safer, as well as give them peace of mind.

MaterCare International will fund the equipment and furniture of the new maternity unit.

MaterCare will also look at funding the renovation of the current maternity unit to maximize the use, ie. Outpatient, laboratory, pharmacy,

The next phase of the project would be providing services for a Level 4 centre providing caesarian sections and staff obstetricians.

MaterCare will also fundraise or search for donors for 2 small outpatient clinics in opposite directions of Nyabwina.

Looking at the site plan and building plan, I suggested to the sisters that maybe reverse the layout of the building for better flow. Enter to the right of the building which would be at the top end of the compound and go to examining to delivery room to post natal ward and basically exit the building on the left once they are healthy enough to leave (usually 24 hours). The “old school’ building can be renovated to provide an outpatient clinic, laboratory, pharmacy, and an education/training room. This would provide separation of services from the new maternity building as well as provide privacy for mothers. The pit latrine between buildings can be moved and should be moved to other side of the compound for public use. As with other health centres, there is usually separate toilets for patients, staff and all other users.

Summary

Out of all the regions we have visited to develop projects to help mothers and babies, Nyabwina is definitely the highest need. Added to lack of any health care is the lack of roads fit enough for travel. The region has high mountains that mothers have to walk up, over and down, women often pregnant and with their other children. The construction of a new maternity health centre will provide the care that mothers deserve. A modern building, fully equipped and properly staffed will ensure that they will receive the best possible care.

Future phase:

• To provide closer outpatient clinics that can save mothers travel time and provide some additional care for mothers during their pregnancy.
• To provide emergency transport such as maternity motorcycle ambulances will help mothers get care in timely manner when the roads are washed out.
• To provide operating room and staff obstetrican for caesarian sections.

The Sisters as well as MaterCare International are grateful to Mrs. Slodzinka and Watoto- Children of Africa Foundation for considering constructing the much needed maternity health centre in Nyabwina, Uganda.