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This little girl is called Takia. She is 10 and here she is being examined by two of CAI's nurses. She is not on ARVs, but she may have early PCP pneumonia.So far she is te only one tested out of 5 children, but one brother is also sick. She lives with her mother, who is HIV+, but who prefers to treat herself with local herbal tablets

The Uganda projects look rather different at the end of 2005.

The Aids Outreach Project

We used to call this the ‘Hospice at Home Project’, but now that drugs are available for the treatment of AIDS in our young patients, their quality of life will be vastly improved and they may live for many years. We still visit our children at their own homes, so we call it our ‘AIDS Outreach Project’.

There are a large number of families affected by AIDS in Uganda, and in some areas it is estimated that about 20 - 25% of young children are orphans. They often live with a sick parent, or with a grandmother or aunt, who may be caring for several orphans. There is much poverty, and a carer often cannot leave the other children and take the sick child to the hospital. The distance may be too far and the trip too expensive.

The little girl is called Hasifah, aged 10/12. This is a typical outreach scene. Her parents are both alive, but were both very sick when Hasifah was accepted by CAI. Here, the team members are answering very many questions from the family

We started this scheme in Kampala, where we offered care and support to 280 children who themselves have AIDS, and are also partly or wholly orphaned, usually by AIDS. The child and family are helped with food if necessary (through the World Food Programme). Each child is visited each month and given treatment to prevent and treat the infections which are common in people with AIDS, and are now also given the antiretroviral drugs (ARVs) which can make such a difference to their lives. Much education, counselling and support is offered to the carers in many different ways, and sometimes we are able to help with household items, like blankets and mosquito nets, and with school fees (donated through an Italian charity) and school uniforms and books.

A typical scene at the carers' monthly meeting at Kayunga. The blue and yellow CAI T-shirts have just been given out.The kids love them.This scene is outside the Hospital.

An American organisation has now set up a programme for Kampala children who have AIDS. This will treat them with ARVs when necessary and follow them up to make sure they are using the treatment correctly. Although not offering the same kind of service as CAI, we nevertheless felt that it was not appropriate to duplicate services in as needy a country as Uganda. We therefore handed over our children to this new scheme, and transferred our expertise and our resources to a district called Kayunga, some 80 km distant, where no other programme for children was in existence.

This picture shows carers learning weaving as an income-generating activity

We started our Kayunga project early in 2005. There is much stigma attached to being HIV+ in this area, and our team spend much time in the villages dispelling the myths and beliefs about AIDS and its treatment, and encouraging people to come forward for counselling and testing and to bring their children too. Already we have over 80 index children and there are many more to come.

We need money to continue this essential work. It is a delight to see how our service can so much improve the lives of these children and their carers and families.

The Rapid Response Project

Mulago Hospital, Kampala, has a very busy labour ward. A baby is born every 15 minutes or so, many of them problem births because of poor ante-natal care, prematurity, AIDS or other illness in the mother and other factors, The midwives have to care for the mother first before attending to the baby, and many babies here need some help in starting to breathe. Babies who do not breathe for several minutes after birth may be permanently mentally impaired or even die. Many babies needed to be transferred to the Special Care Baby Unit (SCBU), and many died.

In 2003, CAI trained six midwives in the skills of neonatal resuscitation, and has paid their salaries as extra staff on the labour ward solely for the purpose of attending to the newborn. Their presence on the ward has greatly reduced the need to send babies to the SCBU and has improved the rate of newborn deaths considerably.

We hope that this team will be taken up by the health services and used as a teaching resource for Uganda for its Care of the Newborn strategy, which is being developed. We need resources to keep this team together until that happens. Please help us.

The labour ward at Mulago. So far this year the rapid response team has attended 72% of all deliveries

The Mothercare Project

Babies and young children are often abandoned in and around Kampala and are brought to Mulago Hospital. Sometimes they are found in pit latrines or rubbish bins. Some are left in the Acute Care Department, sometimes the newly-delivered mother leaves the baby behind when she leaves the hospital. The reasons can only be guessed at: illness in the mother, too many children to care for, extreme poverty or early teenage pregnancy and lack of social support. There may be between 40 – 80 chidren abandoned each year, and there may be 5 or more of them at any one time who need care and affection.

These two abandoned babies are shown in Mulago children's ward playroom. Najib is 2 - he was left in acute care. Small for age and has a large squint.he has been on the ward for two weeks. He is gaining weight, but still very apathetic. Little Stella (in the box) looks about 3 months old, but is thought to be about a year old. she was also abandoned in acute care. She is so floppy that she needs to be propped up in this box all the time. She has not yet been tested for HIV as she is too young for the results to be reliable. She has a cough and general failure to thrive

A child in a hospital like Mulago needs a caring adult to be there too. The adult must provide the child with sheets, clothes, nappies, a laundry service, food and drink and warmth and love. An abandoned child has none of these things.

Our Mothercare project has employed a small team of ‘mothers’ who provide the support and care that a mother would provide, for the time that the child is in hospital. Sometimes the child is returned to the extended family, sometimes rehomed in a children’s home. Many of these abandoned children have some physical defect or obvious ill health. Many are HIV+. Often these abandoned babies have to share a cot with one or two others.

We need ongoing support to continue to look after these desperately needy children. Can you help us?

This is one of our HIV+ children enjoying a hearty meal of beans and rice at the carers' meeting. CAI provides the food, the hospital allows the use of its kitchens, and the carers' committee cooks the food for all comers. Many carers travel long distances to join the meeting. The meetings are part-educational and part social, with drama group, singing and dancing, to enhance the understanding of AIDS.

Playscheme For The Children’s Ward

The children’s ward at Mulago Hospital is crowded, not just with very sick children but also with their parents and carers, who have to ‘camp’ on the wards, under and beside the cots, to care for their children as described above. There is absolutely no space for children who are well enough to run and play.

CAI has decorated one of the children’s wards so that it is bright and ‘child-friendly’. The hospital has let us have a small room off the ward to use as a play-room, This has also been brightly painted and stocked with toys, books and educational materials. CAI pays the salary of a ‘play therapist’, who helps recovering children to relax and play and helps older children, in hospital for long periods, to continue their education.

The playroom is also used for the benefit of the abandoned children.

We need money to continue this inexpensive and much valued service. Can you help us?

Dr Jennifer Green
Hon Country Director, Uganda

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