Dear all,

Dr. Lucille Teasdale developed Lacor with the firm belief in the importance of collecting concise, clear, and reliable data. Today, due to its significant catchment area and daily contacts, Lacor is ideally positioned for the detection of epidemic events and has been part of the Gulu District Epidemic Response Team for decades. Data is a vital component in helping governments and healthcare organisations battle COVID-19 and make decisions to bend the curve.

Uganda’s COVID-19 cases are low compared to Western countries, but the consequences of an explosion of the virus would be devastating. The country would be unable to cope with the level of treatments required by this pandemic.

Lacor has already identified positive COVID-19 patients and staff, who may have gotten it from the community. These infections have resulted in the quarantine of many other staff members, but thanks to early detection and isolation, Lacor has avoided the devastating effects that would have come with closing some of its departments in the peak of malaria season.

Lately, Lacor has improved its data, thanks to the support from IDRC. If these initiatives are further developed, the hospital should be able to strengthen its role as a key site for epidemiological research. In this newsletter, we describe the evolution of Lucille’s early emphasis on data to the hospital’s most recently installed software. We also have a story about the fall-out of pandemic laws and their sad impact on an Ugandan mother and child.

Stay safe and healthy,

Teasdale-Corti Team

Clinic Master, the integrated health information system designed to optimize data collection, is now a reality at Lacor Hospital, thanks to the International Development Research Centre (IDRC) project titled Improving Data Quality for Health Research at Lacor Hospital.

With this achievement, we remember Dr. Lucille Teasdale, the Canadian cofounder of Lacor. Those who were lucky enough to meet her tell how after a busy day of work, Lucille would sit down and cut old x-rays, closing the sides with tape. The useless and discolored plates would turn into perfect folders tasked to defend precious medical reports from the destructive work of rodents in huts, or from the tireless fire dancing under posho cauldrons.

From early on, Lucille believed in the importance of collecting uniform, concise, clear and reliable data. In a few lines she was able to compile a complete history: “No F” meant “no fever,” “No A” stood for “no anemia,” “H L Ok” meant “heart and lungs healthy,” and so on. And everything was meticulously written on the medical form and inserted in the black X-ray folders prepared the night before. Lucille would then give a folder to each patient with the recommendation to keep the medical forms safe for the next visit, and not to use them for anything else, especially money, and to avoid dirtying the forms. That was 40 years ago.

In recent months, Lacor Hospital’s wards and departments are witnessing an unprecedented computer revolution. With the aid of the Clinic Master program, doctors will be able to access and enter all the patient and examination data from their own offices or departments.

The advantages will, hopefully, be huge: doctors will have instant access to complete histories, diagnoses will be faster and more precise, and the margin of error will be significantly lower. The staff in charge of delivering drugs will have no trouble reading prescriptions. No more lost, creased, burned, or muddy papers; no more clinical histories mix-ups. Valeria Calbi, long-time head of Lacor’s pediatrics ward, remembers: “Sometimes mothers would come with another child’s health card, or a 50-year-old man would have a young boy’s report. Health cards would be incomplete, unreadable, or lost.” Patients’ most frequent explanation for lost documents would be that “the papers were burned down with the hut.” Then, a doctor would have to reconstruct the history of past illnesses, previous investigations, or already attempted treatments. It could happen that a patient with a cough would be sent home with an antibiotic prescription, and a week later at a follow-up visit another doctor, unaware of the previous conclusion, would write the same prescription instead of requesting a test to see if there might be another problem, such as tuberculosis.

A lack of concise and centrally accessible data could have dangerous consequences for many. Calbi states: “It wasn’t rare to waste precious time going through old dusty paper archives with no success.” But with Clinic Master, Lacor staff will never again have to spend hours or even days in the dusty labyrinth that of the hospital’s paper archive. Soon the major aspects of patient data will be digitized, thanks to the cooperation of the medical staff from the Outpatient Department and ward. For the moment, this innovation will involve OPD patient files, while for admitted patients doctors will only be required to enter admissions, final diagnoses, prescriptions, and other discharge information in the system.

The consequences? Carolina Laghi, a project assistant working on the introduction of Clinic Master at Lacor, explains: “A huge and precious amount of data will be recorded and easily accessible, to the benefit of patients in terms of quality of history and diagnosis, and to the scientific community as a data foundation for future research.”

“The advantages of data collection aimed at research are priceless: a hospital that cares for 270 thousand patient contacts each year is undoubtedly a gold mine of information, and even more important during COVID-19,” adds Dr. Martin Ogwang, the institutional director of Lacor Hospital who oversees every step of the Teasdale-Corti Foundation projects that are financed by Canadian donors. Dr. Martin continues: “On behalf of our project team, I would like to send my heartfelt thanks to IDRC for our over 10 year partnership and for the funding and all the support received during the implementation of this project.” Samuel Oji Oti, senior program specialist at IDRC, concludes with: “Clinic Master is certainly going to have a significant impact on data quality at Lacor Hospital. I anticipate that the Hospital will become even more responsive to the health needs of the population it serves by becoming a more efficient research platform. This will be a major achievement and I am proud to have supported this project from its inception.”

Today, Lacor manages most patients requiring hospitalisation in the district since patients are avoiding the governmental Gulu Regional Hospital, which for now is the dedicated treatment centre for COVID-19.

The Ugandan government has announced many restrictions, including a travel ban, social distancing, an evening curfew, school closures, and suspension of international flights. Some of these prevent people in rural areas from accessing hospitals. The restrictions are affecting the most vulnerable.

For example, a pregnant Ugandan woman in her late 20s was in labour in a government facility, but was referred to Lacor Health Centre in Amuru, only 6 km away. Due to the curfew and travel ban implemented in response to the pandemic, the woman suffered severe delays since no boda-boda (motorcycle taxi) would agree to carry her. The only one who dared to give her a ride charged her an exaggerated 70 CAN (instead of the usual 4 CAD), and she struggled to find the money. By the time she reached the Lacor Health Centre in Amuru, the baby and mother were in critical condition and required hospital delivery. A Lacor ambulance was called, but although it responded quickly and drove her immediately to the hospital for a caesarean section, it was too late to save the baby. The mother recovered after 1 week hospitalisation.

Every death caused directly or indirectly by COVID-19 is part of us. We share the same pandemic and the same world. We share the same body since we are all impacted by the same ecosystems. We also share the same information and data through the Internet. The Lacor staff is working very hard to find solutions for unexpected challenges that arise due to COVID-19. Your support in donations and in passing the information in this newsletter to others is invaluable to all of us.

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