PROJECT CONCEPT
Club Name: – Rotary Club of Kampala Ssese Islands
Project Title: – Surgeries for 200 Children with Disabilities (Gluteal Fibrosis)
Area of focus: – Disease Prevention and Treatment
Project Location: – Kumi Hospital, Kumi District, Eastern region, Uganda
Project duration: – 2 Years (2021-2023)
Background
Fibrosis of skeletal muscle following intramuscular injection is an iatrogenic condition. The
prevalence has increased conspicuously since the advent of antibiotic therapy. It has most
commonly been reported in quadriceps muscle when outer aspect of the thigh has been chosen
as a convenient site for intramuscular injection and also it has frequently been reported in
deltoid muscle1
.
As per Uganda Bureau of Statistics (2018)2
there are 2.1% of total population living with
disability. But some reliable agencies like World Bank, UNESCO, WHO referred that there is
around 6% to 8% of total population leaving with disability which we consider by our long
term working experience in the field of disability rehabilitation. It is fact that in our country
there are very few rehabilitation centres for persons with disability and most of those are
situated in the cities, whereas around 80% of total Ugandan population live in rural area. Due
to remoteness, lack of accessibility of services a huge number of persons with disability is
denied from the rehabilitation services in the rural area. As a result, the persons with disability
are indeed neglected by their family as well as society and they are segregated from mainstream
society. They have not rehabilitated as on their capacity. Considering the felt need of this
deprived population Rotary Club of Kampala Ssese Islands (RCKSI) is trying to reach those
populations through surgeries for 200 children with Gluteal Fibrosis in Teso Region under
1
Sitati FC, Naddumba E, Beyeza T. Injection-induced sciatic nerve injury in Ugandan children. Trop Dr.
2010;40(4):223–4.
2 Uganda Bureau of Statistics (UBOS and ICF, Uganda demographic and health survey 2016. Kampala, Uganda
and Rockville, Maryland, USA: UBOS and ICF; 20182
Community Based Rehabilitation Project, which is an important means in the way of
rehabilitation of children with Gluteal Fibrosis for their gainful life.
Problem Statement
Given that many people in resource-limited countries perceive injections to be more effective
than oral medications, there is a risk that injections can be used inappropriately by inadequately
trained personnel3
. In addition to infectious complications, disabling musculoskeletal
conditions including gluteal fibrosis and post-injection paralysis have also been linked to
intramuscular injections. These have been reported to occur throughout the world including
Uganda, where these disabling impairments have become common health problems in
children4
. A recently performed retrospective cohort study in Kumi, Uganda demonstrated that
GF and PIP comprise over 30% of clinical hospital visits for musculoskeletal conditions and
40% of outreach visits for disabling conditions in Kumi District5
.
At least 50% of disabilities in Teso can be prevented or treated. We estimate that there are over
2,000 disabled people locally who could be treated, mainly by surgery
Kumi Hospital (KH) was established in 1929 by the Church Missionary Society and is now a
Private Not-for-Profit (PNFP) institution and a member of the Uganda Protestant Medical
Bureau (UPMB). Kumi Hospital has a capacity of 300 beds, employs 6 doctors, 76 nurses,
midwives, and healthcare professionals and has four modern operating theatre rooms. With the
improvements in the government hospitals and health centres, Kumi Hospital has become a
centre of excellence in the region for maternal child health, orthopaedics and rehabilitation,
HIV AIDS care, surgery and eye care.
The village health teams, local health centres and other local hospitals often refer very sick
patients to Kumi Hospital. We operate a community outreach service supporting the local
health centres with specialist healthcare services. We have a functional orthopaedic workshop.
Kumi Hospital operates a policy of treating all patients irrelevant of their ability to pay and we
specifically target the rural poor communities and the highly stigmatised and disabled persons.
We operate a compassionate fund which assists the poorest with hospital fees. We presently
provide general healthcare to the local community of 600,000 within 20 km and specialist
healthcare to the wider community of 2,000,000 within 60 km. The main town is Kumi with
12,000 people.
It is estimated that there are at least a further 10,000 children disabled with Gluteal Fibrosis
which is easily treated with surgery and physiotherapy (cost 300,000 UGX). Gluteal Fibrosis
is caused by injecting quinine directly into the buttocks: this is medical malpractice by the drug
clinics. Most parents cannot afford to pay and we will raise donor funding to set up a campaign
to fix this national disgrace. The children also need ongoing physiotherapy exercises (for the
rest of their lives) to stop the condition returning.
3 Gyawali S, Rathore D, Shankar P, Kumar V, Maskey M, Jha N. Injection practice in Kaski district, Western Nepal:
a community perspective. BMC Public Health. 2015;15:435
4 Ekure J. Gluteal fibrosis. A report of 28 cases from Kumi hospital, Uganda. East and central African journal of.
Surgery. 2006;12:144–7.
5 Alves K, Penny N, Kobusingye O, Olupot R, Katz J, Sabatini C. Paediatric musculoskeletal disease in Kumi District,
Uganda: a cross-sectional survey. Int Orthop. 2018;42:1967-733
The media has been reporting about these cases and raised the concern on the risks. The
National Pharmacovigilance Centre (NPC) has also investigated the cases in Kumi. Several
factors account for this condition including: injection by unqualified personnel, poor quality of
the injection (Quinine counterfeits identified near Uganda Border), irrational use of injection
in community, and unavailability of oral drug (ACTs). The RCKSI, basing on the risk factors,
undertook to do a baseline study to establish facts on the ground and the catchment area. It
included a qualitative study in the Kumi District of Uganda in December 2020, utilizing 20 key
informant interviews with individuals working in healthcare related fields and 4 Focus Group
discussions with caregivers of children living with gluteal fibrosis and post-injection paralysis.
Here below is a link to the first intervention;
Project objectives
a. The project will provide free surgeries for children with disabilities from poor
backgrounds.
b. To train Surgeons in Gluteal Fibrosis.
c. To take a specific ailment approach (vertical) rather than a community based approach
(horizontal) to disability.
d. To correct gluteal fibrosis takes about 30 minutes and is only meaningful with intensive
physiotherapy.
Project Beneficiaries
– 200 Children diagnosed with Gluteal Fibrosis in Eastern Uganda
– 5 Orthopaedic surgeons in Uganda
– Hospital support staff
– Families with children with Gluteal Fibrosis.
Expected Results
– Provision of free surgery and medical operations including physiotherapies
– Trauma counselling to households with children suffering from Gluteal Fibrosis
– Hold sensitization workshops for the community leadership
– Identification and training of Health workers
Project Activities
– Offer 200 Surgeries for children with Gluteal Fibrosis
– Provide physiotherapy camp to the children with physical disability
– Counselling to reduce the emotional stress of the parents having differently able
children and adult in the area
– Monitoring and follow-up
Implementation Plan
– Training in the surgical technique used to release Gluteal Fibrosis in children with
disability will be provided to orthopaedic surgeons in a 5-day workshop that will take
place at Kumi Hospital. This training will be conducted by visiting Orthopaedic
surgeons through the Rotary VTTs who are very experienced in carrying out Gluteal
Fibrosis release on affected children with disabilities.4
– The local leaders are to be mobilised and sensitised about Gluteal Fibrosis in children
with disability
– Rotary Club of Kampala Ssese Islands will selectively identify capable people through
their local leaders to be trained as they give a hand in educating the community
members about Gluteal Fibrosis in children.
– Parents will be taught about all the rehabilitation program of their child and counsel to
manage time for those activities;
– Awareness programme. Educating the community through the regular radio spot
messages on Gluteal Fibrosis.
Estimated Budget
PROPOSED BUDGET FOR 200 CHILDREN WITH GLUTEAL FIBROSIS TO BE OPERATED
AT KUMI HOSPITAL
ITEM
COST
UGX COST$(3760)
Medical Investigation and intervention, Pre and Post Operation
Costs
206,000,000 54,787
Mobilization
335,000,000 8,910
Project Management Costs
52,000,000 13,830
Training Costs
140,476,000 37,361
GRAND TOTAL
733,476,000 114,888
Financing Plan: –
– Rotary Club of Kampala Ssese islands
– International Rotary Partners
– Rotary Foundation
Contact Information
David Rogers Kintu Chris Kayongo Daniella Akello
Tel. +256 772445995 Tel. +256 772448668 Tel. +256 783504750
davidkintu@yahoo.com chriskayongo@gmail.com dakellot@gmail.co