Transforming women's lives

When a team of UNSW Sydney researchers and students arrived in Gulu, northern Uganda, to launch a health project late last year, they weren’t sure how much interest they would receive from the locals.

After months of planning, UNSW Medicine’s Professor Robyn Richmond and representatives from UNSW and Gulu University had made the trek to Gulu, about 340 kilometres north of the capital, Kampala, to launch the Transforming Community Health Project. 

The plan was to interview local women, set up cervical and breast cancer screening services and train local nurses in women’s health services. Women in northern Uganda suffer from high levels of domestic violence and have limited access to reproductive health care. But would they be prepared to speak to strangers about their experiences?

“When we arrived to start interviewing, almost 100 women had already gathered on benches under the lush evergreen mango trees in the grounds of the health centre. The mothers were caring for children, breastfeeding babies, surrounded by goats, dogs and chickens, and flanked by crops of maize,” Richmond says.

Women wait under the shade of mango trees for the team from UNSW Medicine and Gulu University.

“Over the next few days the numbers of women grew. I was so surprised to see that many women, and pleased too, as we were obviously giving them something they wanted.”

The project is part of a five-year community health program in Gulu, driven by the UNSW Institute of Global Development, which continues a relationship formally established by Professor Ian Jacobs in 2016 with a Memorandum of Understanding between UNSW and Gulu University. The project is one of four UNSW initiatives in northern Uganda that aim to improve the lives of people in the region who have been plagued by decades of civil war.

“It profoundly affects you to see these beautiful Ugandan women who live impoverished lives and face huge delays in cancer treatment because of a lack of information, ignorance about cervical cancer and very little early detection of pre-cancerous lesions,” says Richmond, from UNSW’s School of Public Health and Community Medicine. 

The interviews were conducted in groups of three at two local health centres an hour outside Gulu. A UNSW team member asked the women questions in English and these were translated by a Gulu University student or academic into the local language, Acholi, with the answers recorded on tablets.

Fiona Docherty, Vice-President External Relations, UNSW; James Henry Obol, Head of Public Health at Gulu University; Professor Robyn Richmond, UNSW lead of the Transforming Community Health Project; Associate Professor Emmanuel Moro, co-lead of the Transforming Community Health Project, Gulu University.

The survey found that many husbands did not approve of their wives using contraception, more than 40%  of the women had a child who died in infancy or childhood, more than a third suffered physical abuse by their partners and 29%  were hit or beaten during pregnancy.

“In northern Uganda, some women have more than 10 children because their husbands don’t want them to use contraception. It struck all of us how much the women are suffering from domestic violence,” Richmond says.

She found particularly harrowing the story of one woman who was living with HIV, had eight children and whose husband had poisoned himself after he had been suffering from AIDS.

She was saddened by the stories the women told them about their lives as they answered the survey questions, and the impact years of Ugandan violence and political upheaval had on them.

“There are so many public health problems because of years of insurgencies. The women and children have been the casualties,” Richmond says.

As part of the women’s project, 250 women were screened for cervical and breast cancer at the health centres, and those identified with pre-cancerous cervical lesions were treated with cryotherapy. Cervical cancer is the leading cause of cancer-related deaths among women in Uganda. With very low numbers of women screened for cervical cancer, the country has one of the highest cervical cancer incidence rates in the world at 47.5 per 100,000 each year. It is frequently undiagnosed until it has reached stage 4, the advanced stage of the disease.

But Richmond is hopeful that the Transforming Community Health Project will lead to a positive impact and improved health for women living in northern Uganda.

The program also developed and implemented a model to train nurses from health centres in the surrounding districts to teach nurses and midwives how to screen for cervical and breast cancer. In November, 30 nurses from five health centres trained at Gulu University in the theory of cervical and breast screening, followed by hands-on screening practised at health clinics.

“Every month the nurses from the Ugandan Women’s Health Institute, established by President and Vice-Chancellor Professor Ian Jacobs in 2005, are continuing to educate nurses working in northern Uganda, including providing continued support and ongoing quality training,” Richmond says.

Richmond will return to Gulu in 2018 with a UNSW team to focus on the second phase of the project – screening children to determine their ear, eye and oral health and other childhood diseases.

“There are no statistics on the health of children nor programs that exist for children’s health in northern Uganda. Our first step is to find out the diseases existing in children. Because if you don’t know how bad the problem is, you can’t do anything to ameliorate it,” she says.

Donations to the Uganda Transforming Community Health Project can be made online via UNSW here. Please specify the Uganda Health Project in the donation form.