The curious case of Reene Bach: A quack doctor or a victim of malice?

Two-year-old Twalali Kifabi died in July 2013 under the care of Serving His Children (SHC), a charity organisation based in Masese, Jinja. As he writhed in the throes of death, medical personnel grappled to resuscitate him but it was too late for the ailing boy who spent most of his childhood shackled to disease and pain.
The circumstances leading to his death remain contested and this is part of a lawsuit that places an American woman, Ms Reene Bach in the crosshairs. Bach, who is not a physician, is accused in the lawsuit of conducting bogus medical operations that resulted in the death of two children, including Twalali.

In the 131-page suit filed before Jinja High Court by Women Probono Initiative in January on behalf of Twalali’s mother, 25-year-old Gimbo Zubeda, the latter claims that in 2013, her son fell sick and was admitted to Nawandagala Health Centre in Namutumba District.
Twalali was diagnosed with malnutrition but could not afford the “nutritious foods” recommended.

Around July 2013, Twalali fell sick again. A woman, whom Ms Gimbo claims she did not know but later learnt worked with SHC in Masese, implored her to take the child to their facility in Jinja. At the time, Ms Gimbo was pregnant, so she entrusted her mother, Ms Ziriya Namutamba to travel to Masese for Twalali’s medical care. Three days later, she received a call and was told that her child was dead.
“..the woman, who came for baby Twalali, returned the dead child to me and gave me Shs50,000, and left in a car before burial,” Ms Gimbo claims. “I had questions as to what had killed my child; I needed help and explanations, but none was given to me by the women that came back with the body, save for the money that was given to my mother,” she adds.

“I have since heard that the women from SHC were not doctors and may have done something unprofessional that led to the death of my son.”
In the 551-page defence filed in March, Ms Bach and SHC deny ever coercing or convincing anyone to travel to their facility for treatment as the applicants allege. SHC contends that Twalali was brought to their facility by his grandmother wilfully when he was severely malnourished.

“Twalali’s grandmother was given an explanation; the mother has never come to the facility for further explanation nor contacted any staff for the same,” SHC maintains. “The day Twalali was enrolled on July 10, I flew from Uganda to the US for a fundraising and holiday with my family and for the duration of child’s stay, I was out of the country,” Ms Bach says.

An extract of Ms Bach’s passport with an exit immigration stamp dated July 10, 2013 was provided to the effect. Twalali died six years ago but controversy continues to swirl over his death. Medical files seen by this newspaper show he was admitted on July 10, 2013 “as a sick-looking child” with, among others “a lower limbs too weak, a peeling skin, cough, vomiting, diarrhoea, and dehydration”—symptoms of kwashiorkor, an extreme form of malnutrition.
It was stated on the file “the child has been sick for sometime but the sickness was not specified as he was with the mum who later brought him to grand mum, was taken to a clinic, given some painkillers and showed some form of improvement but the condition worsened up to date”.

The allegations
During our investigation, we track down Ms Namutamba in Kizuba Village in Namutumba. She says it is Ms Bach who killed her grandson and she is seeking justice.
Ms Namutamba recounts that Twalali fell sick in mid-July and was taken to Kigandalo Health Centre IV in Namutumba District but medical personnel did not attend to him. In the midst of their desperation, they were told of a team from an organisation—SHC—that was in the area doing some malnutrition outreach programmes.

The SHC agreed to transport Ms Namutamba and her grandson to Masese where SHC handled malnutrition cases. They went through different treatment procedures but Ms Namutamba claims she was not told what her grandson suffered from. She later saw Twalali placed on oxygen.
Ms Namutamba disputes claims that her grandson died of acute malnutrition. She says the same food Twalali fed on was shared with other [grand] children, in her care “so how is it possible that one person can suffer from something and not the rest?”
With the so many vested interests in the case, Ms Namutamba is reluctant to speak to strangers whose ‘allegiance’ she is not sure of.
It takes the Magada Sub-county chairperson alongside the village chairperson to convince her to talk to us, on account that she does not talk to people not assigned by her coordinator, Jolly Semei, a former SHC staff.

Ms Namutamba’s account is, however, disputed by Ms Constance Alonyo, a long serving staff of SHC and now a nurse at Kigandalo Health Centre IV in Mayuge where the charity entered into partnership with the district to provide malnutrition care. Ms Alonyo acknowledges that Twalali was admitted to their facility, then in Masese, but Ms Bach never treated nor saw him at any time, contrary to the claims. “He was severely malnourished when he was brought, and I remember it was our clinical officer, Mr Aggrey Mudasi, who treated him, including putting him on oxygen therapy, which was necessitated to try to save his life but he was too sick; unfortunately, he died,” she explains. “It was our policy that every child who dies, whether in our facility or on referral, we help the family with burial; it is unfortunate that his family misinterpreted the gesture as a cover up,” Ms Alonyo adds.

Twalali’s case bears parallels with two-year-old Elijah Kabagambe, who died last year. Kabagambe’s mother, Ms Annet Kakai, from Buikwe District is enjoined to the suit filed by Women Probono Initiative. Kabagambe did not die under SHC’s care but his mother “believes the medical staff there did something to him” when he was briefly admitted to their facility in Kigandalo in Mayuge.

“Baby Elijah after these events became so weak, after one day; I took him to Nyenga hospital in Buikwe, he was given medication but he would vomit. He died three days later,” Ms Kakai alleges.
Women Probono Initiative accuses Ms Bach of practicing medicine without qualification, and SHC of violating the children’s right to access adequate treatment. The applicant wants court to outlaw the charity from Uganda and pay general damages.

However, Ms Alonyo says Kabagambe was never admitted to the facility. She narrated that the child showed signs of tuberculosis, which they do not treat and advised the mother to seek medical assistance elsewhere.
“I personally told her we could not help. However, the baby was hungry, having travelled that distance from Buikwe to Mayuge, so we gave her milk, which was shared with babies at the time,” she recounts. “Ten days later, we heard that Kabagambe had died--- next we knew we were being sued,” Ms Alonyo says.

She adds: “Bach never treated any child as they allege. Putting on a white coat as they are claiming does not make you a doctor, wearing a stethoscope does not make you a doctor, and you know our local people because she is white they mistook her for a doctor. Sometime I and other doctors asked her to come to assist in, for example, holding down a child to administer an injection or a cannula; that doesn’t mean she treated anyone.”
From the tranche of documents reviewed and interviews with multiple sources, including people on the two opposing sides, it is safe to say claims and counter-claims unfolded last year following a long-running row between Ms Bach and a group of aggrieved staff terminated earlier in 2017.

Bach first came in Uganda in September 2007, straight after graduation from high school in the United States, to volunteer at Amani Baby Cottage, an orphanage in Jinja. In interview with this newspaper, she admitted that she was driven by an imagination to make a difference in Africa. In 2009, she founded SHC, as a community-based organisation running a feeding programme—cooking and providing nutritious foods to malnutrition-struck families—in Masese, Jinja. A year later, the charity upgraded its services to deal with “rehabilitating malnourished children and educating their mothers on how to care for their children.” As a result, the charity hired staff in various fields—social workers, nutritionists, clinicians, doctors, nurses, and others, mostly on freelance basis.

Defence
In her defence, Ms Bach says the malnutrition rehabilitation programme expanded over the course of four years, which compelled them in March 2014 to register as a health centre with the Health ministry.
The chief executive of the Uganda Medical and Dental Practitioners Council (UMDPC), Dr Katumba Ssentongo, acknowledges that in 2014, the organisation was granted a one-year licence to operate.
Early this year, the Health minister, Dr Jane Ruth Aceng, directed UMDPC to investigate the claims against Ms Bach and her charity but in its report, the body said was it “unable to support allegations that children died in large numbers due to the services of SHC both in Jinja and Mayuge districts nor found evidence that Bach “was treating children.”

The alleged deaths in the suit being a medical matter, Dr Ssentongo says they are interested in talking to the families to ascertain the facts—whether there was any foul play or negligence—but “they (families) have been elusive.”
In late 2016, the then officer in-charge of Kigandalo Health Centre IV in Mayuge, Dr Ibrahim Gwaluka, who was gunned down last year in yet unknown circumstances, invited Ms Bach to partner with the district to provide malnutrition care, a process which went through official procedures such as training health workers, before commencing work in April 2017.

Origin of trouble
A few months into the partnership, a section of the retained staff raised several concerns ranging from underpayment, no allowances, and unstable management.
The staff, according to court records and other documents reviewed by this newspaper were Ms Jackline Atim, Ms Joyce Olana, Mr Charles Olweny, and Ms Jolly Semei. Prior to her termination in May 2017, the staff had also petitioned several offices, including the Jinja labour office, the Uganda Medical Union, and Uganda Human Rights Commission.
Ms Alonyo, who was part of the staff protest, recounts that prior to the termination, Ms Bach informed them of the reduced donor funding after the closure, which necessitated a number of changes.

“She told us that those interested to continue working had to reapply for jobs, and we were going to be under government effectively. We protested at first but we had few options; some of us did and others did not agree to it, which means being fired,” she says. “That is when everything started.”

We contacted two other former SHC employees, who are now witnesses for the plaintiffs, to corroborate the claims but they declined to cooperate. Ms Semei, whom we met in Namutumba where he had taken BBC journalists to conduct interviews, says they have enough evidence to back their claims that Ms Bach engaged in medical malpractice. She refers us to another staff, Ms Joyce Olana.
Ms Olana agrees to grant us an interview at the Daily Monitor Bureau in Jinja. On arrival, she interrogates us on how we got her number, why we are interested in the story, and if we were going to pay her. We reveal that we are journalists seeking to establish the truth. She excuses herself to buy airtime from a vendor but never returns.

What lawyer says
In Kampala, Ms Beatrice Kayaga, a lawyer with Women Probono Initiative, maintains that the SHC facility in Masese operated illegally and there were many deaths.
“Based on what she (Bach) had told us, we carried out an independent investigation; had to look for the victims, and enjoined to the case to represent the indigent women,” Ms Kayaga says. An indigent client is one who does not have sufficient income to afford a lawyer.
Asked for her definition of many deaths yet their suit contains only two and both police and Ministry of Health inquiries have found no claimants, she says the driver [Olweny] had given them a testimony that on average, he ferried between five and seven dead children for burial every week. “The issue here is, and our case in court is that SHC had no licence to run as a medical facility, never had qualified medical doctors and Bach participated in treatment yet she does not have a medical licence,” Ms Kayaga says.

Asked whether they were working with No White Saviours Movement, she says: “We have only heard of them but for us our aim is to help the mothers.”
In the suit, 52-year-old Olweny, who joined SHC as a gatekeeper and would rise through ranks to become a driver in 2014, claims he ferried between five and seven dead children back to the villages for burial for an eight-year period, which translates to 2,555 bodies per year and about 20,440 bodies ferried over the last eight years. But beyond these grim statistics, there is little to prove this suggesting that such a claim could be fanciful.

We seek out Olweny for a face-to-face interview but he turns it down, claiming he is in hiding and fears for his life. In a telephone interview, he, however, changes his account: “I did not transport all bodies; sometimes I did, and sometimes the organisation called special hire taxis, others were taken by relatives, and many by boda boda.” Asked for at least five locations where he remembers to have ferried a dead child, he says many families have been bribed and cannot talk to us.

Ms Bach herself says she has been framed and this has turned into torment for her and her family. “My emotion around the situation is disappointment. Doing my best to help the people, and everything turns against me, it is extremely demoralising,” she says.
Ms Bach’s American lawyers say proper procedures were followed and described the claimants as ‘reputational terrorists.’ The High Court in Jinja will commence hearing the case in January 2020.

Background

Start. Ms Bach first came to Uganda in September 2007, straight after graduation from high school in the United States, to volunteer at Amani Baby Cottage, an orphanage in Jinja. In 2009, she founded SHC, as a community-based organisation running a feeding programme in Masese, Jinja District.