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IDI and Mulago: A short trip between Heaven and Hell
By Frankie Edozien


In the 1980s, when the disease dubbed ‘slim’ was first spotted in villages on the shores of Lake Victoria, it seemed a stretch that Uganda would one day get her hands around the pandemic that would go on to decimate much of Africa. And yet for millions of Africans, a beacon of hope has emerged here. In large part, due to the work emanating from a clinic nestled in the hills of this dusty, traffic-choked metropolis.

More than 25 million African lives have been lost to AIDS but since its doors opened in 2004, the Infectious Disease Institute (IDI) has been on the forefront of the continent’s AIDS war.


Founded by academics, the multi-million dollar facility was built to provide, research and first-world patient care. The Global Fund, and the President’s Emergency Plan for AIDS Relief (PEPFAR) are primary funders of its programs.

After being pulled back from the brink of death, many IDI patients are regaining their foothold in society. “People are well. They are going back to work, they are looking for spouses if they’ve lost their loved ones and they are looking to live life again,” said Andrew Kambugu, head of clinical services at IDI, where operating costs are about $2 million annually.

African doctors are flocking here for training to help them replicate Uganda’s success, and Western doctors keep coming. “It’s like Piccadilly Circus! Everybody comes to Uganda and everybody comes to IDI,” said Phillipa Easterbrook, who left London’s Kings College run IDI’s research department. But just a few yards from the ultra-modern IDI with its controlled temperatures, freshly scrubbed floors, and myriad water coolers, sits the famed Mulago Hospital.

The gargantuan Mulago, is Uganda’s premier teaching hospital. Whatever puzzles doctors, they send to Mulago. Moviegoers might recognize its blue and white walls and lush grounds, since many scenes from Last King of Scotland were shot there. From the outside, it seems serene and tranquil like a quintessential place to heal. But once inside, it turns tragic. Especially in ward 4-A, the infectious disease ward that feels like a morgue-in-waiting. Patients, who happen to be the poorest of the poor, once admitted, rarely make it.

There are hardly any facilities and what’s there, is threadbare. The few ripped, paper-thin mattresses, that seem to be four decades old, propped on aging rusty metal beds aren’t available for all. There aren’t any sheets or even pillows and so some make do with the concrete floor. Oxygen tanks, sit there not functioning. Drip stands. There are a few that are barely working. There aren’t drapes on the windows, so birds routinely fly in. And the walls appear not to have been repainted since 1962 when the hospital opened by the Duchess of Kent with working faucets and proper lighting.

On any given night, one single nurse has to take care of some 50 to 80 patients, whose families simply resort to prayer. When young expatriates come to IDI, and then volunteer at Mulago with AIDS and tuberculosis patients, that grim reality knocks them for a loop.
And some decided ‘enough was enough.’ “We just decided we weren’t going to take it anymore,” said Shevin Jacob, 32, from Chicago. He and other asked IDI’s director, Alex Coutinho to visit the nearby ward. Coutinho did and left his plush office into to see what had become of 4-A.

Over the years many Uganda physicians have trained at the infectious disease ward but hardly get to return and so the thinking among some is that few know how bad it has deteoriated.
“He probably hadn’t been here since his student days,” Jacob added. Despite millions in donor funding for miracle drugs, Uganda’s entire health care system is challenged. Mulago is mandated to give care at low cost and the 800-bed facility routinely faces 1,000-plus patients who need admission daily.

“Patients deserve their dignity, regardless of income,” said Mohammed Lamorde, a physician/researcher, who left Nigeria to settle in Kampala because of IDI. Yet many doctors cannot reconcile the flush facilities of the Infectious Disease Institute and the decrepit infectious disease ward at Mulago. Even though dusty dirt roads lead up to the IDI campus, its labs are only one of three certified by College of American Pathologists(CAP) in Africa. Officials were elated when they were picked as the second runner up in the annual ‘Lab of the Year’ 2008, by Medical Lab Observer, an industry trade publication. “Have you seen how much bottled water we have?" And just across the way patients are starving. "What’s this supposed to do to our mental health?” fumed one doctor. By April, after the quiet but steady and forceful complaints from some doctors, IDI brass settled on a ‘4-A project.’ An appeal to donors to funnel some funds to the ward was instituted. 4-A has been adopted by IDI.

Officials say $122 could get life saving medicine for four patients for a week, $600 would get them an oxygen system; $1,223 could get a new hospital bed; and $12,232 for a total renovation. Money has begun to come in.

Jacob who decided to take position at a Seattle hospital last summer, vowed to follow up on the progress. “I will be back to see it through.”

This report is supported by the Project for International Health Journalism Fellowship Program as part of the Henry J. Kaiser Family Foundation’s Media Fellowships.

Donations can be made by contacting idi_communications@idi.co.ug