Uganda hosts the largest number of refugees in the Africa despite its own struggles as a poor nation, earning well-deserved praise from the international migration community. The more than one million displaced persons are mainly from the neighbouring countries of Burundi, Democratic Republic of Congo, and South Sudan as well as Somalia, where war and internal conflict threaten their safety and well-being. It is in this spirit of Ugandan generosity and compassion that Dr Dorah Nampijja conceived and conducted her RHD Action Small Grants project to reach out to the Nakivale Refugee Settlement to raise community awareness and provide health worker education on the control and prevention of RHD.

Nakivale Refugee Settlement is the 4^th largest refugee resettlement camp in Uganda with a population of just under 110,000 people. The Settlement, established nearly 50 years ago, is a city unto itself. Comprised of as many as 70 individual villages, it stretches over 185 square kilometres just outside Uganda’s second largest city, Mbarara. The Settlement, overseen by the United Nations High Commissioner for Refugees (UNHCR), contains numerous schools and health clinics and is bustling with international NGOs, and WHO and UN workers.

Dr Dorah Nampijja is a paediatric cardiologist who practices and teaches in the Department of Paediatrics at the Mbarara University of Science and Technology. She has been involved with Uganda Heart Institute’s RHD Action Uganda-led efforts over the years and she recognised that her neighbours at Nakivale should be included in Uganda’s country-wide RHD prevention and control efforts.

Starting with the Isingiro District Health Officer (the district where the Nakivale Refugee settlement camp is situated), Dr Dorah ambitiously tackled a maize of bureaucracy seeking to obtain the necessary permissions from the Settlement’s authorities to launch her RHD campaign. She was directed to Medical Teams International (MTI), the Settlement’s healthcare provider. After a series of phone calls, rescheduled meetings, and making a personal visit to the facility for a tour and patient walk-through from triage, admission and discharge, she finally received authorisation to hold her RHD sessions. Community social workers and MTI staff pitched in to help Dr Dorah to revise the training and teaching materials for appropriateness in a refugee setting.

On 23 Jan 2019, Dr Dorah and her colleagues, Dr Ssekyanzi Bob and Sister Ndagire, presented a morning RHD workshop for a gathering of 48 health workers that included doctors, nurses, clinic officers, lab personnel, and community health and social workers. Dr Dorah presented the medical overview of the progression of a Strep A infection to Acute Rheumatic Fever to the valvular dysfunction of RHD. This was followed by a hands-on session where participants practiced their new diagnostic skills using tongue depressors on their colleagues. After a lively interactive question and answer session, closing remarks were given by the assistant health in charge to conclude the session.

That afternoon, Dr Dorah and her team conducted another RHD educational session, this time aimed at parents. In all, 428 parents attended the session that was facilitated with the help of KiSwahili and Kinyarwanda translators. Parents were educated about RHD and included information regarding challenges to getting accurate diagnoses, danger signs and symptoms, and treatment and complications of RHD. Session time was devoted to educating parents about the potential danger of a sore throat: how to identify a child with sore throat, signs and symptoms of acute rheumatic fever, and the need to take every child with a sore throat to the nearest health facility for evaluation.

Dr Dorah finished her campaign with a session for teachers and school children at the Nakivale Nursery and Primary School. Working with the Settlement’s education partners – Windle International Uganda –the session was organized for children who gathered under a tree to hear RHD prevention messages presented in Runyankore, a local language, and in English. Schoolbook covers with sore throat prevention messages were distributed. Dr Dorah and her team reached more than 1,000 children from different countries that day – Burundi, Rwanda, DR Congo, South Sudan and Uganda.

Dr Dorah comments:

The pupils we talked to were from primary 3 to primary 7… It took a lot of negotiation and selling of our idea to the school administration and they pitched our idea to the partners until we were given permission. We introduced a means to convey our message to children through something that was very personal to them, that is the book covers that a pupil will behold every day at least for the whole term. The excitement of the children and the questions they asked were very interesting. Also, the fact the teachers did not seem aware of the role of sore throat in acquired heart disease and knowing they had to be more vigilant not only with pupils but with their own children at home.

It is vulnerable people living in the poorest countries that suffer the most from this preventable disease. We thank Dr Dorah and her team for their generosity and efforts to make this meaningful contribution to the global campaign to prevent and control RHD by reaching out to her neighbours who have so little and are displaced far from their homes because of circumstances beyond their control. This is incredible work from a compassionate and motivated team who accomplished so very much with so very little!