One Village, One Voice, One Health

Uganda People's Defense Force (UPDF) Vector Control Officer Lieutenant Julius Iga; Makerere School of Public Health (Kampala) medical student Bernadette Basutta; African Field Epidemiology Network epidemiologist Habert Kazoora; and 411th Civil Affairs Battalion U.S. Army Maj. Daisy Wilson and U.S. Army Col. (Dr.) Richard Birdsong share best medical practices at Nyimbwa Health Clinic Four in Nyimbwa, Uganda, April 18, 2013. In all, UPDF members, U.S. service members in support of Combined Joint Task Force-Horn of Africa (CJTF-HOA) and Ugandan civilian health specialists visited the clinic to share best practices and explore new methods to improve health care at the facility and in the region. The visit was one of the many events conducted during One Health, a military and civil health partnership program, held April 9-26, that recognizes the health of humans, animals and ecosystems, like their nations, are interconnected. Overall, One Health is a whole-of-government venture coordinated by the Ugandan government; UPDF; U.S. Agency for International Development; U.S. State Department; U.S Embassy in Uganda; and CJTF-HOA. (Photo by U.S. Navy Petty Officer 1st Class Tom Ouellette) CJTF-HOA Photo Uganda People's Defense Force (UPDF) Vector Control Officer Lieutenant Julius Iga; Makerere School of Public Health (Kampala) medical student Bernadette Basutta; African Field Epidemiology Network epidemiologist Habert Kazoora; and 411th Civil Affairs Battalion U.S. Army Maj. Daisy Wilson and U.S. Army Col. (Dr.) Richard Birdsong share best medical practices at Nyimbwa Health Clinic Four in Nyimbwa, Uganda, April 18, 2013. In all, UPDF members, U.S. service members in support of Combined Joint Task Force-Horn of Africa (CJTF-HOA) and Ugandan civilian health specialists visited the clinic to share best practices and explore new methods to improve health care at the facility and in the region. The visit was one of the many events conducted during One Health, a military and civil health partnership program, held April 9-26, that recognizes the health of humans, animals and ecosystems, like their nations, are interconnected. Overall, One Health is a whole-of-government venture coordinated by the Ugandan government; UPDF; U.S. Agency for International Development; U.S. State Department; U.S Embassy in Uganda; and CJTF-HOA. (Photo by U.S. Navy Petty Officer 1st Class Tom Ouellette)
Members of Combined Joint Task Force-Horn of Africa (CJTF-HOA) Surgeon Cell and 411th Civil Affairs Battalion; Uganda People's Defense Force (UPDF) Health Services; and Ugandan civilian healthcare specialists share best practices at Nyimbwa Health Clinic Four in Nyimbwa, Uganda, April 18, 2013. The briefing was part of a military and civil health partnership program named One Health, held April 9-26, that recognizes the health of humans, animals and ecosystems, like their nations, are interconnected.  During the briefing, attendees also sought to improve communication between village health teams and clinic staff to strengthen Uganda's healthcare system. Overall, One Health is a whole-of-government venture coordinated by the Ugandan government, UPDF, U.S. Agency for International Development, U.S. State Department, U.S Embassy in Uganda and CJTF-HOA. (Photo by U.S. Navy Petty Officer 1st Class Tom Ouellette) CJTF-HOA Photo Members of Combined Joint Task Force-Horn of Africa (CJTF-HOA) Surgeon Cell and 411th Civil Affairs Battalion; Uganda People's Defense Force (UPDF) Health Services; and Ugandan civilian healthcare specialists share best practices at Nyimbwa Health Clinic Four in Nyimbwa, Uganda, April 18, 2013. The briefing was part of a military and civil health partnership program named One Health, held April 9-26, that recognizes the health of humans, animals and ecosystems, like their nations, are interconnected. During the briefing, attendees also sought to improve communication between village health teams and clinic staff to strengthen Uganda's healthcare system. Overall, One Health is a whole-of-government venture coordinated by the Ugandan government, UPDF, U.S. Agency for International Development, U.S. State Department, U.S Embassy in Uganda and CJTF-HOA. (Photo by U.S. Navy Petty Officer 1st Class Tom Ouellette)
Members of Combined Joint Task Force-Horn of Africa (CJTF-HOA) Surgeon Cell; 411th Civil Affairs Battalion; Uganda People's Defense Force (UPDF) Health Services; and Ugandan civilian healthcare specialists attend an informational briefing at the Nyimbwa Health Clinic Four in Nyimbwa, Uganda, April 18, 2013. Standing left to right, Nyimbwa Health Clinic Four nurse Rosemary Nalweyiso; Nyimbwa Health Clinic Four nurse Officer in Charge Fatima Fawadhan; and Luwero District vector control officer Serunkuma Daniel discuss methods to improve healthcare at the facility. The briefing was part of a military and civil health partnership program named One Health, held April 9-26, that recognizes the health of humans, animals and ecosystems, like their nations, are interconnected. Overall, One Health is a whole-of-government venture coordinated by the Ugandan government, UPDF, U.S. Agency for International Development, U.S. State Department, U.S Embassy in Uganda and CJTF-HOA. (Photo by U.S. Navy Petty Officer 1st Class Tom Ouellette) CJTF-HOA Photo Members of Combined Joint Task Force-Horn of Africa (CJTF-HOA) Surgeon Cell; 411th Civil Affairs Battalion; Uganda People's Defense Force (UPDF) Health Services; and Ugandan civilian healthcare specialists attend an informational briefing at the Nyimbwa Health Clinic Four in Nyimbwa, Uganda, April 18, 2013. Standing left to right, Nyimbwa Health Clinic Four nurse Rosemary Nalweyiso; Nyimbwa Health Clinic Four nurse Officer in Charge Fatima Fawadhan; and Luwero District vector control officer Serunkuma Daniel discuss methods to improve healthcare at the facility. The briefing was part of a military and civil health partnership program named One Health, held April 9-26, that recognizes the health of humans, animals and ecosystems, like their nations, are interconnected. Overall, One Health is a whole-of-government venture coordinated by the Ugandan government, UPDF, U.S. Agency for International Development, U.S. State Department, U.S Embassy in Uganda and CJTF-HOA. (Photo by U.S. Navy Petty Officer 1st Class Tom Ouellette)
U.S. Army Col. (Dr.) Richard Birdsong, a surgeon with the 411th Civil Affairs Battalion in support of Combined Joint Task Force-Horn of Africa (CJTF-HOA), and Abistoria Hassan, a Ugandan civilian animal healthcare specialist, listen to best medical practices during an informational briefing at the Nyimbwa Health Clinic Four in Nyimbwa, Uganda, April 18, 2013. The sharing of lessons learned here is designed to help the clinic improve care for its patients and is one of the many events during a military and civil health partnership program named One Health, held April 9-26, that recognizes the health of humans, animals and ecosystems, like their nations, are interconnected. Overall, One Health is a whole-of-government venture coordinated by the Ugandan government, Uganda People's Defense Force, U.S. Agency for International Development, U.S. State Department, U.S. Embassy in Uganda and CJTF-HOA. (Photo by U.S. Navy Petty Officer 1st Class Tom Ouellette) CJTF-HOA Photo U.S. Army Col. (Dr.) Richard Birdsong, a surgeon with the 411th Civil Affairs Battalion in support of Combined Joint Task Force-Horn of Africa (CJTF-HOA), and Abistoria Hassan, a Ugandan civilian animal healthcare specialist, listen to best medical practices during an informational briefing at the Nyimbwa Health Clinic Four in Nyimbwa, Uganda, April 18, 2013. The sharing of lessons learned here is designed to help the clinic improve care for its patients and is one of the many events during a military and civil health partnership program named One Health, held April 9-26, that recognizes the health of humans, animals and ecosystems, like their nations, are interconnected. Overall, One Health is a whole-of-government venture coordinated by the Ugandan government, Uganda People's Defense Force, U.S. Agency for International Development, U.S. State Department, U.S. Embassy in Uganda and CJTF-HOA. (Photo by U.S. Navy Petty Officer 1st Class Tom Ouellette)
Anima Ibrahim, a 4-year-old patient, recovers from malaria at the Nyimbwa Health Clinic Four in Nyimbwa, Uganda, April 18, 2013. Members of Combined Joint Task Force-Horn of Africa (CJTF-HOA) Surgeon Cell; 411th Civil Affairs Battalion; Uganda People's Defense Force (UPDF) Health Services; and Uganda civilian health specialists visited the clinic to share best practices and explore new methods to improve healthcare at the facility and in the region. The visit was one of the many events conducted during One Health, a 15-day military and civil health partnership program designed to strengthen Uganda's healthcare and counter-bioterrorism capabilities while recognizing the health of nations, humans, animals and ecosystems are interconnected. Overall, One Health is a whole-of-government venture coordinated by the Ugandan government; UPDF; U.S. Agency for International Development; U.S. State Department; U.S Embassy in Uganda; and CJTF-HOA. Ibrahim is expected to return to full health in about two weeks. (Photo by U.S. Navy Petty Officer 1st Class Tom Ouellette) CJTF-HOA Photo Anima Ibrahim, a 4-year-old patient, recovers from malaria at the Nyimbwa Health Clinic Four in Nyimbwa, Uganda, April 18, 2013. Members of Combined Joint Task Force-Horn of Africa (CJTF-HOA) Surgeon Cell; 411th Civil Affairs Battalion; Uganda People's Defense Force (UPDF) Health Services; and Uganda civilian health specialists visited the clinic to share best practices and explore new methods to improve healthcare at the facility and in the region. The visit was one of the many events conducted during One Health, a 15-day military and civil health partnership program designed to strengthen Uganda's healthcare and counter-bioterrorism capabilities while recognizing the health of nations, humans, animals and ecosystems are interconnected. Overall, One Health is a whole-of-government venture coordinated by the Ugandan government; UPDF; U.S. Agency for International Development; U.S. State Department; U.S Embassy in Uganda; and CJTF-HOA. Ibrahim is expected to return to full health in about two weeks. (Photo by U.S. Navy Petty Officer 1st Class Tom Ouellette)
Lance Cpl. Samalay Yassini, Uganda People's Defense Force (UPDF) Public Health Directorate, 2-year-old Norah Nagai, a malaria patient, and Rukia Nazziwa, Nagai's mother, gather for morale at the Nyimbwa Health Clinic Four in Nyimbwa, Uganda, April 18, 2013. Members of Combined Joint Task Force-Horn of Africa (CJTF-HOA) Surgeon Cell; 411th Civil Affairs Battalion; UPDF Health Services; and Uganda civilian health specialists visited the clinic to share best practices and explore new methods to improve healthcare at the facility and in the region. The visit was one of the many events conducted during One Health, a 15-day military and civil health partnership program designed to strengthen Uganda's health care that recognizes the health of nations, humans, animals and ecosystems are interconnected. Overall, One Health is a whole-of-government venture coordinated by the Ugandan government; UPDF; U.S. Agency for International Development; U.S. State Department; U.S Embassy in Uganda; and CJTF-HOA. Nagai is expected to return to full health in one week. (Photo by U.S. Navy Petty Officer 1st Class Tom Ouellette) CJTF-HOA Photo Lance Cpl. Samalay Yassini, Uganda People's Defense Force (UPDF) Public Health Directorate, 2-year-old Norah Nagai, a malaria patient, and Rukia Nazziwa, Nagai's mother, gather for morale at the Nyimbwa Health Clinic Four in Nyimbwa, Uganda, April 18, 2013. Members of Combined Joint Task Force-Horn of Africa (CJTF-HOA) Surgeon Cell; 411th Civil Affairs Battalion; UPDF Health Services; and Uganda civilian health specialists visited the clinic to share best practices and explore new methods to improve healthcare at the facility and in the region. The visit was one of the many events conducted during One Health, a 15-day military and civil health partnership program designed to strengthen Uganda's health care that recognizes the health of nations, humans, animals and ecosystems are interconnected. Overall, One Health is a whole-of-government venture coordinated by the Ugandan government; UPDF; U.S. Agency for International Development; U.S. State Department; U.S Embassy in Uganda; and CJTF-HOA. Nagai is expected to return to full health in one week. (Photo by U.S. Navy Petty Officer 1st Class Tom Ouellette)

Deep in the backwoods of Nyimbwa, Uganda, a tiny village nestled 21 miles north of the country's capital, Kampala, a nurse recounts the morning of Nov. 20, 2012 - the day an 8-year-old girl's illness caught the attention of health officials from halfway around the world.

Rosemary Nalweyiso was on duty at Nyimbwa Health Center Four the morning the young girl was brought in for treatment. At this clinic, where an average of 130 patients arrive daily with diseases ranging from malaria to HIV, the child's illness didn't cause immediate alarm. Before nightfall, that all had changed.

The girl suffered from Ebola, a highly contagious, often-fatal virus transmitted to people from wild animals that spreads into the human population through human-to-human transmission. Because early stages of Ebola resemble influenza-like symptoms, it is not easily distinguishable. Once it was determined the girl had Ebola, panic in the village soon followed - for good reason.

There is no Ebola treatment or vaccine available for either people or animals and the disease has a 91 percent fatality rate. After the infected girl's arrival at the clinic, the disease spread to a nurse who treated her and some village townspeople. According to Nalweyiso, this single case of Ebola claimed the lives of at least three people.

"I was scared," said Nalweyiso. "My first instinct was to run away from the clinic so I wouldn't get Ebola, but I couldn't. I had to stay to help people."

"She was brave," said U.S. Army Col. (Dr.) Richard Birdsong, a physician with the 411th Civil Affairs Battalion in support of Combined Joint Task Force-Horn of Africa. "There was concern that she could catch the disease herself or bring it home to her family, but her care and compassion led to the successful treatment of Ebola."

Nalweyiso's story, and many other similar accounts throughout Uganda, was the reason more than 50 healthcare professionals gathered at the clinic to hear the nurse speak April 19.

The guests were part of One Health, a whole-of-government program held April 9-26 coordinated by the Ugandan government; Uganda People's Defense Force; U.S. Agency for International Development; U.S. State Department; U.S. Embassy in Uganda; and CJTF-HOA to strengthen military, civilian and animal health. The clinic visit was one of many events held by One Health members.

Overall, One Health recognizes the health of humans, animals and ecosystems are interconnected. According to USAID, 61percent of emerging infectious diseases are caused by the transmission from animals, with 74 percent coming from wildlife.

"One Health is a good concept we need to advance," said UPDF Maj. (Dr.) Godwin B. Bagyenzi, director of medical research for the UPDF. Previously, medical professionals, veterinarians, environmental specialists and wildlife scientists would work separately, he said, "but because the high percent of diseases challenging mankind are emitting from animals, we need to work together."

After hearing Nalweyiso's testimony, members of the UPDF, 411th CA BN, and CJTF-HOA Surgeon Cell toured the clinic's campus and discussed best practices to prevent future outbreaks of disease.

Birdsong, a Jackson, Miss., native, said everyone should be concerned about preventing disease in Uganda, including Americans.

Basically, anyone can travel anywhere in the world and get there in less than 24 hours by air, he said. "If a person were to travel to Uganda and contract a disease, they could potentially carry a disease that could become an epidemic, even pandemic, in the U.S."

At every site visit, One Health participants reviewed the sanitation procedures and made recommendations. Like many diseases, Ebola is transmitted from close contact with the blood, secretions, or other bodily fluids of infected people. By employing correct infection-control precautions, such as frequent hand- washing and the use of gloves and masks, transmission can be prevented.

"It's important for all healthcare providers to use universal precautions to prevent the spread of disease," said U.S. Army Maj. Daisy Wilson, a public-health nurse with the 411th CA Bn. "Unfortunately, the clinic's lack of funding for basic medical supplies is an obstacle."

In addition, One Health participants seek to improve communication between all levels of local and regional medical and veterinarian healthcare providers.

"Each village has animal and human healthcare providers," said Wilson, who's from Wagram, N.C. "Our goal is to help them network, build relationships and increase their knowledge of the clinic's capabilities to improve their healthcare system."

For the Nyimbwa health clinic event, USAID arranged for clinic staff to meet members of Ugandan village health teams, who serve as first responders. The health team members commonly refer patients to the clinic, but have never met the clinic's staff.

"They are the first people to be contacted," said Nalweyiso. "If we don't share knowledge, we cannot be effective."

Furthermore, USAID arranged for students from the Makerere University-Kampala College of Medicine to visit the Nyimbwa event.

"It was important to have them attend," said Birdsong. "The students are the leaders of Uganda for tomorrow, and they are the ones who will someday steer its healthcare system."

For Nalweyiso, One Health and its collaboration between UPDF and U.S. service members is encouraging.

"If we all put our hands together, we can save the world," she said.

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