A dream has come true in Uganda - Fondazione Corti

Mauro Fermariello
News from Lacor Hospital
In this issue
Lacor ’s Pediatrics Department............................................................page 2
Piero and Lucille’s meeting with Prof. Burkitt................................page 4
The organization of the Pediatrics Department...............................page 5
Lacor Hospital’s way to microfinance................................................page 6
Dr Corti and Dr Ogwang visit to Canada well received................page 8
2NEWS FROM
LACOR HOSPITAL
A dream has come true in Uganda
Year V – n. 2 – June 2009
2009
Bulletin published by:
Fondazione Piero e Lucille Corti - Milan (I) and
Teasdale-Corti Foundation - Montréal (CA)
Teasdale-Corti Foundation
8880 Boul. Lacordaire – Saint Léonard
QC - H1R2B3 (CA)
Tel. +1.514.253.1737
info@teasdalecorti.org - www.teasdalecorti.org
Bulletin for benefactors and friends interested in keeping abreast on news from
Lacor Hospital and the Teasdale-Corti Foundation
TEASDALE�CORTI
FOUNDATION
FOR LACOR HOSPITAL
Photo by Mauro Fermariello

With 17,626 a d m i s s i o n s a n d 65,000 o u t p a t i e n t s p e r y e a r, t h e pe d i a t r i c s de p a r t m e n t
is t h e Lac o r hos p i t aL ’s busiest o n e , d e a L i n g W i t h u p t o 400 p a t i e n t s e v e r y d a y d u r i n g t h e
p e a k seasons (ma y-oc t o b e r ). so m e 59,958 a d d i t i o n aL c h iL d r e n a r e t r e a t e d in t h e ho s p it
a L’s th r e e pe r i p h e r a L he a L t h ce n t e r s.
Lacor’s Pediatric Department
An interview with Dr Nyeko Richard
Lacor Hospital’s Pediatrics Department comprises a Children’s
Ward, an Outpatient Department called the Young
Child Clinic (YCC), a Nutrition Unit and an Isolation Unit,
however there are plans to move the latter under the Department
of Medicine in the future. It also includes a small Neonatal
Unit for premature babies which was set up very recently,
and a unit for patients affected by Burkitts lymphoma (a
childhood cancer endemic in equatorial Africa) admitting
patients up to 17 years of age, while all other units in the Department
admit only patients under 6 years of age. These represent
38% of the hospital’s total number of contacts (inpatients
and outpatients) and get treatment totally for free,
except for a token fee in the YCC. Pregnant mothers also get
totally free treatment. This is how the hospital seeks to help
families in a region where most people live below the poverty
line.
Dr Nyeko Richard, a qualified pediatrician and Head of the
Department, explains that the major cause for admitting children
under five to the Hospital is malaria (40% of all admissions,
in line with the national rate). According to the WHO,
every 30 seconds a child dies from malaria in Africa, causing
a loss of 1.3% of annual economic growth in countries with
intense transmission and cutting attendance at school and at
workplaces. The second most common cause of children’s ad-
Bulletin from Lacor - page 2
mission is infection of the respiratory tract, including pneumonia,
accounting for about 27% of all admissions and is followed
by diarrheal diseases, anaemia (often a complication
of malaria), malnutrition and septicemia, and then by other
infections and skin diseases.
Dr. Nyeko, what is the major cause of death in your department?
Dr Nyeko Richard, Head of the Pediatric Department
Surprisingly, it is not malaria: our main cause of death is pneumonia,
causing 18% of child mortality. Malaria, accounting
for approximately 16% of deaths, is the second cause, followed
by malnutrition and septicaemia. Our death rate in the
last 6 years has ranged between 3 and 4 percent, taking into
account children admitted for severe acute malnutrition. But
when you consider the general pediatric ward alone, it is less
than 3%. Even at a national level, mortality for severe malnu-

trition is still very high. Many deaths occur within the first
24- 48 hours of admission and they are mainly referrals. The
main issue for this department is late referral: patients simply
arrive here late. Often the damage has already been done.
Meningitis, for example, often comes with complications. In
our communities, people are not used to going to the hospital
as soon as they discover they have a problem. They first go
to their neighbours, or the traditional healer, and then to the
drug shops… It’s only when they fail all these that they come
here.
What are the most common treatments by the local traditional
healers?
We have many cases of “ebino” and “tea-tea”. Ebino is the extraction
of the child’s unerupted canine teeth, believed to cause
such diseases as diarrhea, vomiting and fever. Tea-tea is also
very crude. They cut the child’s skin deep on the chest walls or
on the hands and feet, and claim to remove millet grains. Of
course, these practices are not performed under sterile conditions,
so cases of sepsis and infections are frequent. We have
been and are still fighting these practices through educational
activities in the villages, but they are very hard to eradicate.
Lacor Hospital treats HIV-positive mothers with anti-retrovirals.
What is the rate of mother-to-child transmission of the virus?
I don’t have the exact figures but we still see a high number
Mauro Fermariello
of children infected by way of vertical transmission. It is not
only during delivery that they get infected, as breastfeeding
also increases the risks of transmission, and our poor mothers
can’t afford other kinds of replacement feeding. Another issue
is hygiene: even when artificial milk is provided (through
NGO-sponsored programs), it can never be guaranteed due
to poor living conditions in the villages. That is why these children
often come back to us with diarrheal diseases and other
infections. Most of them may die before their first birthday.
However, the hospital has a programme for preventing mother-to-child
transmission of HIV infection, which can reduce
the risk many folds. Through this program, approximately
500 pregnant mothers every year are treated with anti-retroviral
therapy. Unfortunately, the follow up of mothers and
children after the delivery is still a challenge, and as a result we
cannot estimate the exact impact of this programme on our
patients.
Regarding malnutrition, who is admitted to the unit?
Bulletin from Lacor - page 3
We admit patients with severe acute malnutrition, when the
life of the child itself is threatened. These patients are managed
in 2 phases. Phase I is a stabilization phase lasting 7 days on
average. It mainly involves treatment and prevention of complications
and the patients are given special therapeutic milk
called F75. Their weight is monitored constantly. Those with
edema are expected to lose weight during this phase as they
lose the excess fluids, before starting to regain weight. Transi-

PIERO AND LUCILLE’S MEETING WITH PROF. BURKITT
Burkitt’s lymphoma was studied in Uganda and described for
the first time by the surgeon who discovered it, Denis Parsons
Burkitt, in 1958. It is the most common cancer of children in
equatorial Africa. When Piero and Lucille first arrived in Uganda,
in 1961, they were lucky enough to personally meet Denis
Burkitt who, at the time, was working at the Mulago university
hospital to which they had been assigned for an internship
that was supposed to last 1-3 months, and was mandatory for
the inclusion of foreign doctors. After a short interview, Professor
Burkitt stated that both Piero and Lucille were eligible, thus
exempting them from the mandatory internship.
Quoted from the book “Un rêve pour la vie” by Michel Arseneault:
“For years he had been obsessed by a strange disease, a mysterious malignancy
that especially hit children aged 4–8. (....) He had begun to systematically
photograph them and had noticed that the diseased children,
with a jaw swelling, sooner or later developed other cancers in the abdomen.
(...) Lucille and Piero followed Burkitt in the operating theatre. (...) After the
very simple surgery, Burkitt asked Lucille to describe how many operations
she had carried out. From the beginning of her internship, she explained,
she had carried out a few hundred operations, some highly complex, and
had worked side by side with surgeons who had taught her avant-garde
techniques. In particular, she had assisted Doctor Collin, who had operated
on an esophageal atresia, one of the first operations of that kind
tion is an intermediate phase: the children’s absorbtion capacity
has now increased, so they are changed from F75 to F100,
which has more calories, and are monitored for a few days.
The children are then moved to phase II, the rehabilitation
phase. They are now stable and able to eat food, so this is when
we start them on nutricam, a special, balanced semi solid food
made from local ingredients, and prepare them for discharge.
It is essential that these children be fed very regularly. We have
on average 40-60 of these patients per day in our unit. During
the war times, they used to be more than 100. The mortality
rate for these patients is about 7-10%.
You also have a dedicated unit for Burkitt’s lymphoma. What
kind of lymphoma is it?
The Burkitt’s lymphoma, which is endemic in this area, is the
most common childhood cancer in Equatorial Africa and
Bulletin from Lacor - page 4
affects children much more than adults. It has a high chance
of involving the jawbone or the abdomen. It is a highly aggressive
cancer, often life threatening but also one of the more curable
forms of lymphoma. We generally admit approximately
90 such patients per year and their number is steadily increasing.
There is a high chance for a good outcome of treatment,
but the chemotherapy lasts 3 months, which is a long period if
you consider the indirect costs of treatment (for patients and/
in Canada, in 1956. The alimentary
tract of a newborn baby had to be
reconstructed. (...) Piero observed
the scene. As he had already been
able to often see, Lucille was not
talking surgery, she was celebrating
it! Her theoretical knowledge
and practical experience could not
be questioned. In addition, an unquestionable
enthusiasm, sometimes
innocent but never naive.
- Well - Lucille concluded – now you
know the essential. This afternoon,
what are we going to do? Burkitt’s
answer came immediately.
- Clearly, he told them, there’s no
need for you to stay here. There’s
no point in your watching me operate,
when you have so much to
do in the North. No, it’s better that
you go up to Gulu. There they certainly
need you”.
This was the beginning of Piero
and Lucille’s long adventure
at Lacor.
A typical Burkitt’s case from the
Cortis’ photo archive
or their attendants who are unable to work during hospitalization),
so sometimes the patient fails to complete the cycle.
What is your typical working day?
A busy one. The rainy season, beginning in the end of April, is
our peak season. It is when malaria strikes more: we can have
on average over 400 in-patient contacts everyday. So the work
is much.
What are the challenges for your department?
Well, we use very simple technology so our challenge is more
on the staffing side. We have many diagnostic facilities that
other hospitals don’t have, so we attract many patients. As I
said, our number of contacts is very high. In order to improve
the quality of our service, I think we need an optimal balance
between patients and personnel. And we need training. The
world is moving fast and medicine is changing fast, therefore
we would need people to specialize in areas such as pediatric
intensive care, neonatology and others.
Chiara Paccaloni

g
THE ORGANIZATION OF THE PEDIATRICS DEPARTMENT
Lacor Hospital, together with the 3 Health Centres built in
peripheral areas of Lacor, serves a large geographical area
in Northern Uganda with a population of more than half a
million people. Being the reference hospital, it also receives
patients from as far away as Sudan. In 2008, children aged
under 5 accounted for 56% of the total number of inpatients
in the hospital. Every day on average 300 children reach the
pediatrics outpatients department (Young Child Clinic - YCC),
which is not surprising when we consider that the examination
and drugs cost less than 40 Euro cents. Admission is free
of charge.
The Pediatrics Department consists of:
- A general Children Ward, divided by sectors-diseases
(emergency, day-hospital, malaria, cancer, pneumonia,
diarrhea, anemia, neo-natal). There are 106 beds, with a
bed occupancy rate of more than 150% (2008). This means
that a third of the children must sleep on mats, just as
they do at home, because there are not enough beds for
everybody;
- Serious Malnutrition Unit (40 beds, 716 admissions in
2008), divided into sectors according to disease seriousness
(intensive, intermediate and pre-release nutrition treatment);
- Isolation Unit for contagious cases (20 beds);
- Neonatal Unit for premature children, with 10 small beds
in a solar heated room (recently built);
- HIV-AIDS Clinics (203 children under treatment as per today)
and for sickle cell anemia (newly established).
Children with serious surgical diseases are ‘concentrated’ in
specific times of the year when surgery is performed by teams
of pediatric surgeons coming from abroad. A vaccination
service is guaranteed to all children (in and out patients)
that come to the hospital: if necessary, the child is vaccinated
before going back home.
There were 4,465 deliveries in 2008: these babies were examined
before release. Of them, 500 were born from HIV positive
mothers and were given preventive treatment against
the vertical transmission of the HIV virus. These are figures of
a large children’s hospital; these are the classic diseases of an
African hospital with the addition of complex cases referred
from other hospitals. Malaria is the first reason for admission,
followed by lung diseases and malnutrition. The overall mortality
in the department in 2008 was 4%.
A hospital is a reliable observatory of the general situation of
the area’s population. Mothers and children coming to Lacor
Hospital show signs of great poverty and overall difficulty.
Malnourished children did not exist before the war, yet they
continue to be admitted in the Gulu district, often as terminal
patients: more than 7% of them die in the ward. We can
estimate that for each malnourished child admitted, at least
2 more are left behind and die at home. Besides, children’s
poor general nutrition affects their defense against infectious
diseases, which means they can even die from ordinary diarrhea;
mothers’ malnutrition implies that many children are
born with low weight and/or prematurely. Global health va-
lues (indicators) in the Gulu district show a clear difference
with those of the Nation: for every 1,000 children born, 149
die within their first 12 months, compared to “only” 88 in the
rest of the Country, life expectancy at birth is 40.9 years in
Gulu and 48.1 in the rest of the Country.
Mauro Fermariello
One must be aware that disease treatment in a child is the
last ring in a chain with prevention among its other rings.
The global service provided by the hospital’s health centers
is methodic and without interruptions and includes vaccinations,
monthly weight check, healthcare and nutrition education,
identification of children at risk, promotion of treated
mosquito nets, administration of Vitamin A every six months,
worm disinfestation. Mothers are also encouraged to deliver
in a safe environment, with the help of a professional, not at
home. This reduces maternal and newborn mortality. Morbidity
and mortality figures of the hospital are regularly transmitted
to the District Health authorities. Prevention will then
rely on the analysis and assessment of these figures in order
to act in a targeted way at the level of the health centres.
The value of treating ill children goes beyond the mere survival
of a patient. The most precious wealth of a poor family
is represented by its children, and little else. Offering a child
treatment service (offering it in a way which is appropriate,
professional, human and free-of-charge) means acting where
the need for help is more widely felt and requested. It means
disseminating a sense of normality among a population
afflicted by years of conflict. It also means peace, social justice,
development.
The disease of a child is part of the possible events in the life
of a family and death cannot always be avoided. Assisting a
dying child is however possible and necessary, as necessary is
sympathizing with their parents, relieving their anxiety, being

there at the moment of death. A doctor absorbs this “marginal”
aspect of treatment from the surrounding environment,
in particular from the behaviour of nurses (of local language
and culture): Lacor’s nurses, trained within the hospital,
know how to combine professionalism with natural skills of
empathy, sensitivity and understanding. True, they are also
mothers themselves …
The operation of a single department and the quality level of
care given to patients depend on the constant presence of
appropriate every-day use tools (from syringes to catheters, all
disposable), of even expensive yet necessary machines (such
as, for example, oxygen concentrators), of drugs (the most
effective, from antibiotics to anticancer drugs), of adequate
nursing staff. If you have all this, you manage to provide adequate
services and save human lives. All those ancillary services
must be added to these resources which allow or confirm
a diagnosis (radiology, laboratory, bacteriology, endoscopic
investigantion, bioptic examinations) and those which ensure
more advanced treatment (pediatric surgery, island for
premature babies, intensive care, specialist clinics). St. Mary’s
Hospital guarantees all these services, with rare interruptions
in the availability of drugs and/or consumables. All this gives
the opportunity to work well, to be effective. The only “drawback”
would be patient overcrowding: nothing like good healthcare
performance convinces people to use it.
The Pediatrics Department of Lacor belongs to children and
Mauro Fermariello
mothers: there are no limitations in terms of space, time or
requests. At night the floor becomes a huge dorm, to move
where you must step beyond the bodies of mothers and
children. They sleep on mats, a dish of food “appears” from
nowhere, it is always surprising to see how they can deal
with the difficulty of being in a shelter away from home, nearly
always with little money, lack of communication, often
accompanied by another child in addition to the one who is
ill. Yet it all happens in serenity and extreme dignity. Once the
children are better, they rush as they wish in the large area in
front of the wards: observing their liveliness, joy and trust is
the reward for the effort made for their health.
Massimo Serventi, pediatrician
It takes us only 13$ to treat a patient
In Ug a n d a, m o s t people l Iv e o n less t h a n 1 dollar per d a y. WIth a n e m p l o y m e n t r a t e o f 3.2%, t h o s e W h o
h a v e a s a l a r y c a n p r o v Id e f o r t h e needs o f a f a m Il y, generally m a d e U p o f 10/15 p e r s o n s, b U t t h e n t h e m o n e y
Is totally s p e n t o n f o o d. ho W t h e h o s p It a l h e l p s Its Workers h a v e access to e d U c a t Io n, h o U s In g, f a r m In g.
Lacor Hospital’s way to microfinance
The Hospital’s loan cooperative
“The cost of living has doubled in Uganda in the last 7 years
and this trend doesn’t seem likely to decrease”. This is why
Nyeko-Rac Thomas, Health Educator at the Lacor Hospital,
decided to join the Hospital workers’ loan cooperative.
He became a member five years ago and has so far benefited
from five loans. Until this year, he has used them to pay for
his children’s school fees (he has three of his own and two
“adopted”). “My older daughter, who is 15, is especially fond
of school. She likes it a lot. When it seems there could be not
enough money to pay for the fees, she pulls a long face…” The
problem with school fees is that they have to be paid with a
three-month advance, otherwise the student must stop attending
school, an unfortunate and quite shameful experience
for both the kids and their family. For the moment Nyeko-
Rac Thomas has always succeeded in keeping his children in
school. Besides, this year the loans have also allowed him to
buy a small plot of land, in Lacor, the nearest village to the hospital.
The price was quite high, approximately US$460, due
to land’s position, a mere 50 m away from the village center.
He also plans to have his own house built there, in 5 years’

Mauro Fermariello
time. He has already designed it: 90 sq. m, three bedrooms,
a sitting room, a bathroom and a store. The kitchen will be
built outside and it will also serve as an additional room. He
is also already building a hut for his guests, with the help of
Brother Elio’s workers, from the Technical Department. According
to his estimate, the cost of the house will be on the
whole approximately 10 million shillings (US$5,000). Add to
that the cost for the hut (about US$270) and the land itself
(almost 1 million Shs), the expenses are high and could not
be afforded without external financial support. The hospital’s
zero-interest rate loan cooperative was founded in 1997 with
the help of the Italian Cooperation which donated start-up
funds of 123 million shillings. The hospital also lent further
135 million. The aim of the cooperative is to support its junior
employees, with low salaries, in facing necessary expenses. Mr
Otema Francis Kitara, treasurer of the cooperative since 2006,
explains that, by statute, money can be lent only to finance
school fees and the acquisition of land for farming or building
one’s house. “Further needs can also be financed as an
exception, in case for example someone is sick and can only
be treated in another hospital (if they could get treatment in
Lacor then it would be free) and the cares needed are very ex-
The payment of
school fees is one
of the main reasons
why Lacor Hospital’s
workers join its loan
cooperative
pensive.
Providing interest-free loans, the cooperative has an yearly
loss due to high inflation and to some sporadic cases where
the person has not been able to pay back (mainly due to
death or more rarely to deliberate insolvency). This is why
the hospital keeps injecting capital once in a while, but the
cooperative represents an indirect advantage for Lacor since
such a benefit is a strong means to fidelize its employees.
The loans are paid back in up to 2-3 years, through the help of
the Hospital which directly withholds the monthly amount
from payroll and gives it back to the cooperative. Loan
amounts are decided on the basis of the member’s household
income: the monthly reimbursement must not exceed one
third of the salary. As per today, 398 workers are benefiting
from its loans and there have been 600 since the beginning
Bulletin from Lacor - page 7
of its activity. The entry fee is 45,000 Shs (about US$20). In
11 years, the loans issued have amounted to 1,760,073,500Shs
(about US$ 902,602).
“Nyeko-Rac” means “envy is bad”. And quite curiously,
Nyeko-Rac Thomas doesn’t seem affected by envy in any way.
Maybe it’s because he has found a way to face his family’s essential
needs.
Chiara Paccaloni

DR. DOMINIQUE CORTI AND DR. MARTIN OGWANG VI-
SIT TO CANADA WELL RECEIVED
Dr. Corti was among well known participants at the Montreal
Millennium Summit, featuring also Iranian Nobel
Peace prize winner Dr. Shirin Ebadi, the Governor General
of Canada Michaëlle Jean, economist Jeffrey D. Sachs,
actress Mia Farrow and the Duchess of York Sara Ferguson.
Thanks to the initiative of Daniel Germain the Summit
united international speakers and activists to discuss and
exchange ideas on human development, poverty, health
and solidarity.
The Lacor Hospital was at the heart of the Summit and
awareness was raised to the cause. “With only 13$, we
can treat one person” was Dominique’s personal message
to the public. Making it clear that it takes one step at
a time to reach our goals. The presentation was received
with a warm standing ovation.
The photography exhibition Lacor Hospital: An African
Success Story, was displayed at the Summit and created
quite a stir. The 60 images taken by well known Italian
photographer, Mauro Fermariello, show the Lacor Hospital
and its context in northern Uganda. “Originally operated
by a few Italian missionaries, we now have on staff
almost 600 Ugandans”, quoted Dr. Martin. Close to 3,000
guests were present at the Summit and all had an opportunity
of viewing the exhibition on what has grown into
one of the best non-profit medical centres in equatorial
Africa. The exhibition is proof of the hospital’s legacy of
empowerment and helped create more awareness of Lacor’s
work.
Dr. Corti along with Dr. Ogwang, the institutional director
of Lacor Hospital, then made their way to the University of
Toronto for the 7th Annual Global Health Research Conference:
Convergence of Maternal and Child Health organized
by Judy Kopelow of the Centre for International Health,
Dala Lana School of Public Health. The Lacor Hospital
Bulletin from Lacor Hospital - page 8
THE TEAsdALE-CorTI FoundATIon
The Teasdale-Corti Foundation is a charitable organization
created to contribute to the support of the Lacor
Hospital in northern Uganda.
Reg. N. : 890520745RR 0001
rEFErEnCE
Filippo Campo - f.campo@teasdalecorti.org
Tel.: +1.514.253.1737
8880, boul. Lacordaire, St-Léonard, QC.
H1R 2B3 (CA)
was showcased at the Conference Opening Reception
and Dr. Ogwang was also speaker in a panel on perinatal
morbidity and mortality.
Saundra Diardichuk
Dominique Corti at the Summit in Montreal
Dr. Martin Ogwang, Dominique Corti and Filippo Campo (Teasdale-
Corti Foundation) at the Millennium Summit in Montreal
donATIons
Donations to the Teasdale-Corti Foundation can be sent
by mail to:
8880, boul. Lacordaire, St-Léonard,
QC, H1R 2B3 (CA)
or online: www.teasdalecorti.org
nEws From LACor
is a bulletin offered to all who wish to receive news on the
Lacor Hospital and the Teasdale-Corti Foundation. It is
published by Fondazione Piero e Lucille Corti (Milan,
Italy) and Teasdale-Corti Foundation (Montreal, Canada).