Background

Uganda faces considerable challenges in the provision of paediatric surgery and care for children and young people. 48% of the rapidly-growing population – currently 44 million people – is under the age of 15. A youthful demographic, economic fragility, and limited government expenditure on public health have combined to result in poor healthcare outcomes. Training opportunities for physicians are limited, with only 10 students successfully completing postgraduate surgical training in the country each year. The mortality rate for children under the age of 5 is approximately 69 deaths per 1,000 live births. Despite significant improvements in recent years, a continued effort remains essential in order to achieve Sustainable Development Goal 3.2. This goal, as defined by the World Health Organisation (WHO), seeks to reduce neonatal mortality to fewer than 12 deaths per 1,000 live births and the under-5 mortality rate to fewer than 25 deaths per 1,000 live births.

The majority of paediatric conditions are easily remedied with routine surgical procedures but, if left untreated, can lead to lifelong disability or premature death. An absence of high-quality surgical care will not only continue to result in the preventable disability and death of millions; but is also estimated to reduce the gross domestic product of low- and middle-income countries by up to 20% by 2030 (Lancet Global Health, April 2015). Ensuring high standards in paediatric surgery is therefore a priority, and EMERGENCY’s Centre of Excellence in Paediatric Surgery will contribute to an accelerated reduction of child mortality in Uganda and neighbouring countries.

This new project typifies the organisation’s humanitarian ethos: a vision of mutual respect which recognises the equal rights and dignity of every human being. In line with our Manifesto for a Human Rights-Based Medicine, EMERGENCY advocates the right to be treated; a right which belongs inalienably to each and every member of the human community, irrespective of socio-economic status, gender, sexuality, race, language, religion, or political belief(s). In the words of Renzo Piano, the renowned architect with whom we are collaborating to design and build the new centre in Entebbe, “the strength of EMERGENCY is based on its focus on beauty as well as on the practice of medical excellence; the sense of justice, the rejection of war, and the pursuit of harmony.” These fundamental principles are embodied in the design for the new Paediatric Centre in Entebbe. It is to be, as envisioned by founder Gino Strada, “a place full of joy and love.”

The Facility

We are almost there: three years on from the start of construction work, the new Paediatric Surgery Hospital in Uganda is now almost complete.
Due to the ongoing COVID-19 pandemic and restrictive measures implemented by several countries around the world, the start of activities – scheduled for April 2020 – has been postponed to the second half of the year. Some of the international staff who had already arrived in Uganda for the start-up phase of the project have been reassigned to support EMERGENCY’s response to the COVID-19 crisis.
Meanwhile, structural work has been completed, as well as fittings and furnishings. The final touches will be made during the summer while we conducted interviews for the selection of local staff.

In February of 2017, we began work on the Centre of Excellence in Paediatric Surgery in Entebbe. On the banks of Lake Victoria, the centre sits 35 kilometres from the Ugandan capital, Kampala. This new facility is dedicated to the specialist care of children and young people.

The entire compound is 120,000m² in area. The main hospital facility will occupy 8,700m² and have a capacity of 72 beds, 6 of which will be within an intensive care unit (ICU). Included in the ICU will be a neonatal intensive care facility. The hospital facility will consist of the following:

• Emergency Department (Open 24/7)
• Outpatients Department (Open 8am – 4pm, 6 days per week)
• Diagnostic Department (Open 24/7)
• Laboratory and Blood Bank
• Operating Block (Including 3 Operating Theatres and the ICU)
• Inpatient Wards
• Pharmacy
• Administrative Office
• Technical Department
• Ancillary and Domestic Services (Laundry, Maintenance, etc.)
• Guesthouse(s)

The centre will embody a number of core principles. Chief among these is a concern for environmental sustainability. The centre will make use of innovative technologies to minimise its environmental impact and maximise sustainability. It has been designed with energy autonomy in mind, and the end product will be a facility that is fully self-sufficient and sustainable, making use of the available natural resources. The centre is to be equipped with systems that will create a comfortable environment for both staff and patients, while also respecting low environmental impact standards. Two integral aspects of the environmentally-friendly design are as follows:

1) The traditional method of ‘rammed earth’ construction will be used to build the hospital. This is an ancient building technique involving a mixture of earth, sand, gravel, binding agents, and a little water; which is then compressed and dried in wooden frames or moulds. Used in this way, these materials provide thermal inertia, ensuring temperatures and humidity remain consistent throughout the year. Rammed earth construction makes use of abundant natural resources, providing an ideal low-impact and renewable solution for the construction of the Paediatric Centre.

2) The centre will generate its energy from the sun. The roof will be constructed from a suspended trellis framework supporting a total of 3000m² of photovoltaic solar panels: an area equivalent to one football pitch. This system will produce 300kW/h and ensure that the hospital has a secure electricity supply which renewably satisfies its energy demands. The photovoltaic roof, ‘floating’ above the building, will also shade the hospital and all uncovered walkways. Born from the earth, powered by the sun.

Consideration for the holistic health and wellbeing of patients is at the heart of the centre’s design. It is to be a healing space in every sense, and patient recovery will be aided by close proximity to nature. Floor-to-ceiling windows will be fitted throughout the hospital, flooding rooms with natural light and ensuring that the beauty of the park and the surrounding natural environment can be fully enjoyed. Cool areas of shade in the botanical park, inspired by the gardens in nearby Entebbe, will engender a sense of serenity and promote the healing process. Abundant greenery and naturally illuminated spaces will free patients from the anxiety of their day-to-day situations: the first step towards successful recovery. Considerable space will also be devoted to play areas, both indoor and outdoor. Play is healing, and a fundamental element on the road to recovery. Dedicating space to play is one way to ensure that each child’s stay in the hospital can be as relaxing and cheerful as possible; and ensures that, as far as possible, fears and anxieties can be minimised.

The African Network of Medical Excellence

The African Network of Medical Excellence (ANME) is an innovative model of humanitarian intervention designed by EMERGENCY, with multinational support from the Health Ministries of the Central African Republic, Chad, Democratic Republic of Congo, Djibouti, Egypt, Eritrea, Ethiopia, Rwanda, Sierra Leone, Somalia, South Sudan, Sudan, and Uganda. The aim of ANME is to develop an integrated network of medical centres of excellence on the African continent. The first of these facilities – the Salam Centre for Cardiac Surgery in Khartoum (Sudan) – was opened in 2009. To date, patients with acquired or congenital cardiovascular diseases from a total of 28 countries – in both Africa and further afield – have been treated at the Salam Centre. The Centre of Excellence in Paediatric Surgery in Entebbe will be the second major project under the jurisdiction of ANME.

The centre’s primary catchment zone for emergencies will be Central Uganda, with a population of approximately 6,500,000 people (nearer 9.5m?). Under the integrated ANME referral system, however, patients from a vast area will be able to access the centre’s facilities; including the rest of Uganda and other African nations. This project will strengthen ANME, lending it greater versatility and ensuring that the highest standard of paediatric treatment is available, free of charge, to those who require it.

Project Aims

The Centre of Excellence in Paediatric Surgery in Entebbe will address several medium- to long-term objectives. The centre will treat paediatric surgical conditions and contribute to the reduction of the mortality rates among infants, children, and young people. In line with EMERGENCY’s founding principles, all services will be absolutely free of charge.

As with many other EMERGENCY facilities, the hospital will provide education in surgery, medicine, nursing, and supporting roles: training and qualifying professional staff from Uganda and beyond. The purpose of this is to build and sustain local capacity, and to ensure that full operational autonomy is achieved. EMERGENCY will guarantee the international staff required to meet high clinical standards and facilitate the proper training of national medical and non-medical personnel. Particular attention will be devoted to improving the management skills of administrative and ancillary staff to ensure the smooth running of the centre. As in all EMERGENCY facilities, priority will be given whenever possible to vulnerable or disadvantaged social groups.

An international team of approximately 20 people (consisting of both medical and non-medical staff) will initially be based in Entebbe. EMERGENCY aims to gradually reduce the number of international staff permanently present however, while concurrently increasing the responsibilities of local personnel. As above, the hospital in Entebbe will therefore be a teaching environment. Dedicated to medical education, the hospital will not only provide excellent paediatric care but will also become a regional training centre for health professionals. Young nationals (from Uganda and neighbouring countries) will have access to specialised training and accreditation. The aim is to develop and retain young medical professionals, encouraging them to remain in their home countries and strengthen national health systems without feeling the need to satisfy professional ambitions abroad.

Over the past decade, the international donor community has devoted significant resources to developing the health sector worldwide; paying particular attention to both man-made and natural disasters and aiming to increase effectiveness in disease prevention and primary healthcare delivery. Despite these longstanding efforts, however, the overall impact of conventional approaches in strengthening national health systems remain unsatisfactory. The Global Health Observatory (part of the WHO) explains that the rate of decline in maternal and child mortality across the African continent in the past two decades is still “largely off-track”. Improving the health of entire populations – particularly of those most vulnerable groups – depends on the ability of national health systems to deliver effective, quality, and comprehensive medical care; while simultaneously developing the holistic competencies of medical professionals. While preventive measures and primary health care are undoubtedly of fundamental importance, the widespread provision of advanced tertiary medical infrastructure is integral to achieving positive health outcomes and improved economic development. EMERGENCY actively supports the development of autonomous national health systems by building permanent medical infrastructure and training local staff and professional medical personnel.

Design and Construction Partners

EMERGENCY is collaborating with a number of partners to design and construct the new facility in Entebbe. The renowned architectural firm Renzo Piano Building Workshop has designed the hospital, in collaboration with Studio Tamassociati. Structural planning has been developed by Milan Engineering and plant design provided by Prisma Engineering.

The Ugandan Government is participating actively in the project, and has donated the plot where the centre is currently being built.