Tucked away on the edge of Bwindi Impenetrable National Park in southwestern Uganda, Bwindi Community Hospital (BCH) offers life-saving care to one of the most remote regions in East Africa. Bwindi Community Hospital cares for more than 100,000 people living in the South Western corner of Uganda. The Hospital is located twelve hours drive from Kampala, the capital, on poor roads, two kilometres from the Eastern border of the Congo and one kilometre from Bwindi Impenetrable Forest.
Bwindi Community Hospital is a Church of Uganda (Anglican) Hospital under the Diocese of Kinkiizi. It is staffed by a team of 121. These include; doctors, nurses, midwives, other health workers and support staff. 70% of our employees are from within our catchment area and 30% are from other parts of Uganda.
The Founding and Early Years
Founded in 2003 by American missionary doctor Scott Kellermann and his wife Carol, the hospital began as a modest clinic under a tree, created to serve the indigenous Batwa pygmies. When Scott and Carol Kellermann began their work in Bwindi in 2001, they came as missionaries to help the Batwa pygmies. Bwindi Community Hospital was founded in 2003 by Scott and Carol Kellermann. It began as an outreach clinic under a tree, and has grown into a 155-bed hospital providing health care and health education services to a population of over 100,000 people in Uganda.
The hospital began with a special mission to help the Twa or Batwa pygmies who were displaced from the Bwindi Impenetrable Forest after it was made a national park in 1991. Batwa pygmies inhabited the Bwindi Impenetrable Forest for thousands of years, but became conservation refugees largely as a result of efforts to protect endangered mountain gorillas.
Moved by the pleas of the Batwa community to stay, the Kellermanns proceeded to sell their California home and medical practice and relocate their lives to Uganda. Delivering medical services was a challenge as there were no hospitals or clinics in the region. The only option for treatment was to bring services to people through mobile medical clinics. We drove as far as the road allowed and then carried our medical supplies to villages at the edge of the forest. Vigorous drumming by the Batwa spread the message that health care was available. Typically, our clinics attracted 300 to 500 patients per day. Our intensive care unit was established under the shade of a tree. The work was exhilarating; this was medical practice in its purest form.
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While the hospital was started particularly to provide health care to the Twa, it quickly found itself treating all people living in the area. Quickly they realized a lack of healthcare was not limited to the Batwa, but extended also their neighbors, the dominant Bakiga tribe ( 92%). There are few other decent health services in this extremely remote area and people sometimes walk for more than a day to get to the hospital. Some people had to walk 20 kilometres to get to the nearest health centre to receive treatment for their health problems.
In the process of living among the Batwa, we came to learn their language, culture, and traditions. Another benefit of our new lifestyle surprised us. Exchanging that hectic lifestyle for the simplicity of life in a tent was a gift to us. We talked long into the night regarding how, as a couple, we could deal with the travails we faced. I was exceedingly grateful to be loved by, accepted, and integrated into the Batwa community.
After we’d spent a few years providing mobile clinics, the village elders became convinced that we needed to establish a permanent clinic. They approached us and asked, “Can we work together to prevent the deaths of our pregnant mothers and our children?” From this collaboration was born Bwindi Community Hospital.
Bwindi Impenetrable National Park
Expanding Services and Community Outreach
Bwindi Community Hospital serves more than 100,000 people in the Kanungu District. It provides both preventive and curative services. With 155 beds and over 120 staff, it addresses everything from childbirth and infectious diseases to dental and eye care.
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Delivering medical services was a challenge as there were no hospitals or clinics in the region. The only option for treatment was to bring services to people through mobile medical clinics. We drove as far as the road allowed and then carried our medical supplies to villages at the edge of the forest. Vigorous drumming by the Batwa spread the message that health care was available. Typically, our clinics attracted 300 to 500 patients per day. Our intensive care unit was established under the shade of a tree. The work was exhilarating; this was medical practice in its purest form.
Mothers can safely deliver babies thanks to skilled birth attendants and a dedicated maternity ward. The hospital runs a neonatal care unit, significantly reducing infant mortality in the region. With this in mind the hospital has developed a specialist unit for sick newborn babies and children. The neonatal unit is the only unit for a population of 300,000 people in the whole district of Kanungu.
BCH created a Mothers’ Waiting Hostel, where expectant women from remote villages stay before delivery. Given the remote location and little reliable means of transport, it is usually hard for a mother to come when she is in labour. The hostel was donated by the Australian embassy. This innovation ensures they reach skilled care in time, reducing maternal deaths.
Adding the money spent on staff, drugs, electricity and other supplies it costs about $30 a day to keep a child in Hospital. The average family in Bwindi lives on about $1 a day and has seven children. They do contribute a small amount, but the local community cannot afford the full costs of care.
Poor roads and lack of public transportation mean that many people cannot reach the hospital. Village health promoters (VHP) work together with Bwindi Community Hospital to reach the people who cannot come to the hospital. This is a pioneering project where knowledge and skills about health are shared with every village and household in the Bwindi area. One of two hundred VHP's trained by Bwindi Community Hospital, are easily recognizable by their green T-shirts and the positive attitude towards helping the community. Through the Community Health Team at the hospital, a strong linkage exists between the hospital and the community.
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Bwindi Community Hospital is much more than just a hospital where sick people stay to receive treatment. The Community Health and Batwa team together with the Village health teams make up a large part of the services provided by the hospital. Every two years a Household Survey of all homes in the Bwindi area is conducted to measure the progress of the Community Health interventions led by the hospital.
eQuality is a community health membership scheme that was launched in March 2010 as a mechanism to help people of the Bwindi area have access to equitable, quality, and sustainable health care services affordable to all. The scheme, which is in its third year of operation, has had its membership grow to 24,323 as of June 1, 2012. The very way that health insurance works is that the whole community “pools” their money to care for each other. When they need to go to the hospital they have paid their 6,000 UGX (US$3) per person per year. The pooled money is available to pay for their treatment.
Bwindi Community Hospital sends its HIV team into the surrounding area three days each week for a mobile testing and treatment clinic. The HIV team takes a portable CD4 machine with them on outreach clinics, which counts the cells that the HIV virus attacks. With this machine the team has results within eight minutes of taking a blood sample. More than two hundred local people living with HIV have joined one of the hospital's patient support groups, which meet in different parts of the Bwindi area each month. Some members of the patient support group have also started teaching in schools. They have been trained by Bwindi Community Hospital in basic teaching methods, and run lessons about HIV prevention and stigma-reduction in every classroom in the Bwindi area. More than 1,000 people test for HIV each month. Every two years the hospital conducts a community survey that provides information about which parts of the Bwindi area have the largest number of untested people.
Uganda has one of the highest fertility rates in the world at seven children per woman, and has the youngest population on the planet with a median age of less than fifteen. Large families trap people in poverty with not enough money for food, schooling and health care for their children. High fertility rates are dangerous for women, and make it hard for them to escape traditional childbearing roles. Three years ago very few couples in the Bwindi area were accessing family planning (birth control). Now the contraceptive prevalence rate (proportion of women of child-bearing age using some form of contraception) is 28%. Bwindi Community Hospital, in partnership with Family Health International, has trained 40 village health workers to be able to give contraceptive pills and injections. Now more than 500 women a month access their contraception through this network.
BCH continues to focus on their health needs through mobile outreach, immunization drives, and nutritional support. Specialist clinics are held each week for children with long-term diseases. Bwindi's child health services get support from Sustain for Life, a charity in the UK and TOUCH Uganda in the United States but there is a lot more to be done.
Each month more than 500 children visit the Outpatient department and more than 100 are admitted to the ward. The leading health problems are respiratory infections, malaria, diarrheal diseases and malnutrition. On average 15 children are admitted every month with malnutrition. Outside the ward is a children's play area, a kitchen and a demonstration garden where mothers (and occasionally fathers) can learn skills about how to grow and cook a balanced diet for their children. The ward staff organizes practical cooking sessions with the mothers of the admitted children every week. These are always preceded by singing and dancing.
Malaria has always been the biggest killer in the Bwindi area, and is easily preventable simply by sleeping under a mosquito net. Many people still suffer from diarrhea because they don't know enough about how to access clean water, and families go hungry because they don't have the knowledge and skills to be able to grow and prepare a balanced diet.
| Health Indicator | Details |
|---|---|
| Life Expectancy (Twa) | 28 years |
| Life Expectancy (Average Ugandan) | 53 years |
| Family Planning (Batwa women) | 1 out of 14 |
| Family Planning (Bakiga neighbors) | 1 out of 4 |
Collaborations and Partnerships
BCH partners with the Uganda Nursing School Bwindi and Uganda College of Health Sciences Bwindi. These institutions train nurses, midwives, and clinical officers.
Once the hospital’s initial structures had been completed, along came our many Rotarian friends. Through a grant from The Rotary Foundation, District 5190 (parts of California and Nevada) sent a container outfitted with the first X-ray unit in our region. Best of all, a Rotary team came to assist with the installation. Another Foundation grant was secured to facilitate rainwater collection, protect springs, and provide sanitation to prevent diarrheal diseases. Rotary Foundation grants provided equipment for surgical, pediatric, and medical units, as well as neonatal and adult intensive care units, at the Bwindi Community Hospital.
BCH works closely with local leaders to ensure sustainability. It trains community health workers who educate families about sanitation, nutrition, malaria prevention, and reproductive health.
Tucked away on the edge of Bwindi Impenetrable National Park in southwestern Uganda, Bwindi Community Hospital (BCH) offers life-saving care to one of the most remote regions in East Africa. BCH created a Mothers’ Waiting Hostel, where expectant women from remote villages stay before delivery. Given the remote location and little reliable means of transport, it is usually hard for a mother to come when she is in labour. The hostel was donated by the Australian embassy. This innovation ensures they reach skilled care in time, reducing maternal deaths
For a very long time, Sub Saharan Africa has been known as one of the regions with leading infectious diseases outbreaks. Most outbreaks have come from these countries, especially, Uganda, and her neighbours in the Central African regions such as the Democratic Republic of Congo (DRC). Together with partners; the Epicentre for Emerging Infectious Diseases and Intelligence (EpiCenter), University of California Davis, (UCDavis), Uganda Virus Research Institute (UVRI), Uganda Wild Life Authority (UWA), Gorilla Doctors and Rugarama Hospital, BCH has embarked on both animal and human population disease surveillance. During the last 25 years, human and animal populations have never been at a higher risk of infectious disease spillover.
This research work began in 2021, and the disease surveillance focuses on arboviruses, filoviruses, and corona viruses, which cause such diseases as Zika, Ebola and Covid-19 which are known to cause devastating outcomes in affected populations. Human populations living near wildlife such as near Bwindi Impenetrable National Park (BINP) are at increased risk of zoonotic spillover. Given Bwindi Community Hospital’s proximity to both the Democratic Republic of Congo (DRC) and the Bwindi Impenetrable Forest with its rich population of primates and bats, there is a heightened risk of zoonotic disease spill over, such as Ebola. Through the Bwindi mHealth project for example, researchers are working to improve data capture at the point of zoonotic spillover. Community health workers, commonly known as Village Health Team (VHTs), and community members, are being empowered to report both human and animal health data using a basic non-smartphone-based system.
Working with local communities, and then empowering them strengthens emerging infectious disease surveillance, research, and outbreak response. With this project, early detection is enhanced and timely interventions carried out, hence, preventing future epidemics. Disease spillover from human to animals and vice-versa (also referred to as zoonotic spillover) first occurs near the forest and then to urbanising areas where viruses adapt to human-to-human transmission.
Addressing Traditional Practices
For almost twenty years now, I have regularly visited southwestern Uganda, where I have sought to improve oral health literacy and learn more about “Ebino”, a practice in which primary, mandibular, canine tooth buds are removed from infants by traditional healers. Babies selected for this practice are most commonly febrile, but any apparent malady or pathology makes them targets. At times it is performed prophylactically to ward off future illnesses. Babies with intellectual or developmental disabilities (IDD) are no exception, as anxious parents seek remedies to health issues that are seen as remarkable.
Ebino, loosely translated to mean false teeth, is termed more descriptively in scientific literature as “infant oral mutilation” or IOM. It is performed by the Abafumu at the bequest of worried parents. While results of this practice are usually limited to loss of primary canines or collateral damage to permanent teeth, occasionally there are consequences far more serious, including sepsis, tetanus, HIV transmission or death. The procedure itself is performed utilizing a variety of instruments including wire, bicycle spokes, or razor blades. Because this “remedy” has no relationship to the underlying condition, critically needed medical care is often postponed and complicated when Ebino is performed. Further, because no anesthetic is utilized, young children are physically restrained during this painful procedure.
I was not there to change Warren’s attitudes toward the practice, simply to learn more. He proudly shared that he had learned the art of his medicine from his father who had in turn learned from his father. There is a saying that, around the world anyone who engages in healthcare, no matter what the approach, surely must have a love of his fellow man and this was evident in Warren.
Seeking their collaboration in a respectful manner while at the same time improving the oral health literacy among rural populations looks the most promising approach. A year later, I mentored 2 pre-dental students who spent 6 months conducting oral health literacy surveys throughout the sprawling Kanungu district, assessing attitudes among family decision makers towards the practice of ebino.
The hospital has a history of successfully collaborating with abafumu; re-training them as “village health promotors” on other public health campaigns that have resulted in improving TB medication compliance rates and increasing proper bed net use for malaria prevention. It is our hope that a similar collaborative effort will work with IOM reduction. It was encouraging to see survey results reflecting that where ever overall health literacy levels were higher, the practice of IOM was less prevalent.
Traditional Healer
Looking to the Future
A nursing school is being built next to the hospital to further facilitate the training of local people in the skills and knowledge of nursing. The hope is to both provide a school and a training place for any interested student. BCH partners with the Uganda Nursing School Bwindi and Uganda College of Health Sciences Bwindi. These institutions train nurses, midwives, and clinical officers.
The gift of several years and many trips to Bwindi has allowed me a birds-eye view to the witness many successes at the Bwindi Community Hospital. I have seen the power of long relationships in building trust and mutual understanding. This has led to many good outcomes, the most recent being a new dental and vision care clinic that will also serve to train future vision and dental officers. This will help to address Uganda’s critical need for qualified providers. I look forward with hope to the coming years of continued collaboration with Bwindi Community Hospital, working to increase oral health literacy and community prevention efforts while respectfully engaging in collaborative efforts to discourage the practice of IOM.
Today, Sunday, September 29th, 2024, marks the Twentieth Anniversary of the formation of the Kellermann Foundation. Recognizing the faithful and sacrificial work of Dr. Scott and Carol Kellermann, Dick Panzica, Don Fultz and Robert Michelin gathered around Dick’s kitchen table with Scott to form a 501 (c)(3) foundation to oversee and guide the work of the Bwindi Community Health Center (BCHC) as it was named at the time.
In the years to come the Kellermann Foundation would grow to have three fully-operational partner ministries:
- Bwindi Community Hospital
- Uganda Nursing School Bwindi
- The Batwa Development Program
Over the last 20 years these organizations have been the means by which hope and health have been extended to the Batwa people and thousands like them living within the surrounding community.
Many visitors to Bwindi Impenetrable National Park for gorilla trekking also visit the hospital. You can tour the facility, support a health initiative, or volunteer. Bwindi Community Hospital is more than a health facility. It’s a story of hope, resilience, and innovation. From saving newborn lives to empowering the Batwa community, it continues to uplift one of Uganda’s most underserved regions. Book a Uganda safari that includes Bwindi Impenetrable National Park and a guided visit to Bwindi Community Hospital. You’ll witness mountain gorillas, meet local changemakers, and support health initiatives.
Prior to his arrival, there was virtually no medical care available for 120,000 people, most of whom had to walk long distances to get help for preventable diseases.What started out as a clinic under a Ficus tree, is now a 150-bed full-service hospital ranked among the best in Uganda. Its services include medical and surgical care, a colorful pediatric ward, a neonatal unit for premature or sick infants, demonstration gardens, a Waiting Mothers’ Hostel where expectant mothers can safely stay before giving birth at the hospital, community health outreach programs and much more.
Health Care Needs of the Batwa and Bwindi Community: A Global Solution
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