Talemwa prioritises quality healthcare for patients

A s I stepped into the reception area of TMR International hospital in Kampala, I was struck by an unexpected sense of warmth and comfort.  Unlike the sterile, antiseptic scent that typically envelopes hospital corridors, the air here held an atmosphere of familial comfort amidst challenges of illnesses.
Dr Daniel Talemwa, the executive director, greeted me with a genuine smile, his demeanour more akin to that of a gracious host welcoming a guest to his home. We headed to the boardroom for our interview. 

Together with his team, they have been providing health care to patients with critical illnesses since 2016. Having previously worked in South Africa, Dubai and briefly in the UK as well as serving as a healthcare doctor in the Iraq and Afghanistan wars, Dr Talemwa borrowed the idea of offering quality health care to patients while making them comfortable by all means. 

“Areas like the Intensive Care Unit (ICU) are crucial for people with respiratory problems. The premature newborns also need specialised care. We also extend pre-hospital services by providing critical care before the patient arrives at the hospital, but also when the patient is actually in the hospital,” Dr Talemwa explains.

Comfortability
The hospital’s homely ambiance aims to offer solace to caregivers assisting patients, while the labour ward is furnished with amenities facilitating water births for expectant mothers. 

This specialised provision allows mothers to experience floatability in a bath tub, aiding in pain relief during labour while also enhancing the comfort of newborns. With the belief that the modern era has come with solutions to problems faced by humanity, mothers are also offered a painless service called epidural, where an injection is administered to take the pain away.

Getting innovative
Having attained the International Organisation for Standardisation (ISO) certification, the facility has been positioned to enhance the quality of life for patients.

In a stride towards medical advancement, the facility introduced cochlear implants, a revolutionary procedure aimed at restoring hearing abilities for individuals facing hearing loss challenges. To keep with the ever-changing technology, staff are equipped with skills to use the machinery as well as social skills to relate with patients effectively.

In order to adapt to evolving technology, the staff undergo continuous training to proficiently operate machinery and develop interpersonal skills to effectively engage with patients. They prioritise gathering feedback from clients to ensure they meet their expectations and continuously enhance the quality of our services.

Challenges
While institutions such as Makerere University produce doctors, Dr Talemwa says there is not adequate technology where they can express their skills. Because of this, they find themselves looking for greener pastures in other countries. 
“It is worth noting that the government has made efforts to improve payment for scientists, and teachers are also receiving better compensation. However, many doctors are leaving the country  because there is lack of technological support for the medical knowledge they have acquired as well as the relatively low remuneration compared to other countries,’ Dr Talemwa notes. 

Because the facility’s services come at a slightly higher fee compared to the normal standards of service provision, Dr Talemwa says there is usually the dilemma between providing the quality of healthcare and its cost, something that to the community yet looks cost-effective in the long run.

He observes that the challenge of providing health services as a business is multifaceted. Initially, healthcare services were primarily government-run, but now, with increasing privatisation, there is a struggle to balance financial viability with the expectation of free or affordable healthcare.  

In Uganda, the cost of medical equipment and services is comparable to international standards, yet the ability to break even remains a significant hurdle. While passion drives innovation and quality, Dr Talemwa states that sustainability requires a delicate balance of attracting clientele who can afford high-end services, leveraging insurance support, and seeking partnerships for financial assistance. 

Despite these efforts, affordability remains a critical issue, particularly for high-end critical care services like cochlear implants and ICU stays, which are beyond the means of many in the community. 
“Advocacy and planning are essential to address these challenges, ensuring access to necessary care while alleviating the financial burden on individuals and institutions,” Dr Talemwa says.

Safety culture
Bearing in mind that in the African culture one ill person affects the whole family, the facility practices family centered care, an innovative program to improve the patient and their family’s outcomes and satisfaction.
“We engage the family and discuss the care that the patient needs and guide them where necessary on the opportunities available and the steps to take especially for pregnant mothers,” Dr Talemwa explains.

He adds: “Midwives are consulted once an expectant mother has taken up the antenatal package and every trimester pregnant mothers talk to specialists and midwives who are going to deliver them. This is to ensure that once the midwife has built a rapport with the mother, they take them all the way through until they have actually delivered.”

Dr Talemwa says staff members have been empowered through pioneering a policy offering four months of post-delivery care for maternity staff mothers and establishing dedicated spaces for staff mothers to breastfeed, express milk, and engage in patient care activities comfortably.

The solution
According to Dr Talemwa the solution to affordability is advocating for universal health care insurance where people can access medical care without hardships as well as the government developing a system that can grade the private sector according to services provided.

 “If someone gets into an accident and it is a head injury, they take them to the nearest clinic. But in most cases, they are unable to handle, and there is time wastage when they are trying to do what they can before they take you to another care. And yet, if you moved to a capable facility you would be saving a lot of money,” Dr Talemwa says. 
He perceives that the system is hard for community members who are unable to differentiate the various designations of medical workers.

Cochlear implants
Dr Talemwa notes that a cochlear implant is applied to people born without hearing abilities and those who have lost hearing during the course of their lives.

“But for those who have lost their hearing at birth, there’s a cut-off age that if we do not put the implant within that time you will not benefit from it and usually it is between four to five years. Children who are much predisposed to be born with this health problem are usually premature or born with very low birth weight, they have been in Neonatal Intensive Care Unit for a very long period of time or mothers who had infection, like mumps and measles when pregnant, affecting children, ”Dr Talemwa explains.

The skill is performed by a professor from New York who visits Uganda two to three times a year since the skill is not yet available in Uganda. With his arrival four to seven surgeries are done. After the surgery there begins the journey of rehabilitation that takes up to three years. 
“Our collaboration with a professor who conducts training sessions at Makerere University is helpful. Following the training, the professor performs surgeries whereby the staff and students from university witnesses this, tapping the skills,” he adds.

Achievements
Since its establishment the hospital has treated about four cases of tetanus to success.  Dr Talemwa reflects on the response and support that the facility offered during Covid-19 period in 2020 and 2021 something that tested their resilience. 
With the infrastructure designed to support critical care services, they ensured uninterrupted oxygen supply to patients, eliminating the need for cumbersome cylinders. This positioned them to effectively meet critical care needs such as oxygen provision.

“My team and I got an advantage by being active during the first wave. So we did a lot of investment in terms of personal protective equipment for our staff and also training on how to prevent cross infection,” he says, adding that amidst fears and myths about the Covid-19 vaccine he took it up by hooking the rest of the team.