Dr Henry Sendikadiwa, the medical officer in-charge of Nakasongola Health Centre IV.
Alice Nakachwa, 25, first noticed liquid-filled blisters on her chin. Within days, they spread to her neck, armpits, and back. Two weeks later, her one-year-old child developed similar symptoms. Seated on the ground outside her round, mud-and-grass-thatched house in Kalungi Village, Nakachwa tended to her freshly chipped kasede (dried potato chips), her face hidden behind a red veil to conceal the lesions and scars left by Mpox. “I did not know it was Mpox. I thought it was smallpox.
I believe I contracted it while caring for my six-year-old daughter in Kanyonyi,” she says. Mpox, first recorded in humans in 1970 in what is now the Democratic Republic of Congo (DRC), spreads through direct contact with infected individuals or animals. Declared a public health emergency, Uganda has recorded 2,247 confirmed cases, with Kampala reporting 347 and Nakasongola 84. The worst-hit area in Nakasongola is Lwampanga Town Council, a busy trade hub linking northern Uganda and the DRC, which has recorded 19 cases.
On the frontline
The Mpox outbreak in Nakasongola was first reported in 2022, with the fishing community (25 cases) and commercial sex workers (13 cases) among the most affected groups. Primary school children (11 cases) and housewives (10 cases) were also impacted. A lack of knowledge and inadequate resources initially hampered response efforts. Dr Henry Sendikadiwa, the medical officer in-charge of Nakasongola Health Centre IV, recalls the early days as chaotic. “Diagnosing Mpox was a major challenge. It took 21 days to get results for the first suspected case. One patient even fled the isolation facility and travelled to Iganga.
Our knowledge of Mpox management was limited, making those first days extremely difficult,” he explains. To combat the outbreak, Dr Sendikadiwa and his team collaborated with district officials to establish a holding area at Lwampanga Landing Site and a treatment centre at Nakasongola Health Centre IV. “We had to cover initial costs out of pocket, including feeding the patients. The Ministry of Health only stepped in with food support after three weeks.
With no dedicated Mpox staff, I reassigned existing health workers and adapted Covid-19 management practices,” he says. Setting up the treatment centre required relocating the antenatal and eye clinics. Resources were stretched thin, with 12 beds taken from the main health centre, forcing some patients to sleep on the floor. The isolation unit operates with just two permanent nurses and four doctors. Mothers and children posed a unique challenge. “We created family rooms within the tent, but preventing children from interacting with others was difficult. Fortunately, no children in the isolation centre became infected,” he says.
Early cases were severe, especially those with genital lesions. Limited resources strained care efforts, with only one kettle available for patients requiring warm saline soaks three times a day. Managing sex workers and fishermen in the isolation unit required security personnel, and keeping patients from escaping was a constant concern. “We have observed that the method of transmission affects severity. Patients who contracted Mpox through sexual contact often experience significant emotional distress,” he notes.
Overwhelmed but determined
The early days of the outbreak were gruelling. “I practically lived at the facility, even attending task force meetings on Sundays,” Dr Sendikadiwa recalls. Beyond Mpox, he manages the entire health centre, performing up to 100 surgeries monthly and attending district task force meetings. Resource limitations made matters worse. “I spent my own money on patient care.
We set up the initial isolation facility without external funding until the World Health Organisation (WHO) intervened,” he says. The psychological toll was immense. Memories of the Covid-19 pandemic, which claimed 37 Ugandan healthcare workers in 2021, haunted staff. “There was fear that Mpox would be as deadly. I was afraid to go home and still hesitate to visit. It has affected my normal life, psychology, and finances,” he admits.
A model response
KATDespite challenges, Nakasongola’s Mpox response has been lauded for its proactive approach. Weekly coordination meetings, active surveillance by Village Health Teams (VHTs), and efficient sample transport have played crucial roles. Many initially mistook Mpox for heat rash (ennoga) or chickenpox.
To counter misinformation, health authorities, supported by World Vision, conducted sensitisation campaigns targeting cultural leaders in Kalongo, Kalungi, Mayirikiti, Nabiswera, and Nakitoma. World Vision also funds risk communication efforts, using bodaboda-mounted megaphones and training 100 teachers from 25 schools on infection prevention.
Paul Mayembe, World Vision’s Nakasongola programme area manager, says the organisation has provided Shs380m to the district task force for healthcare management. The strategy is now being replicated in Ntoroko, Mayuge, and Buliisa.
The need for psycho-social support Recovering from Mpox extends beyond physical healing. Stigma and social isolation persist. Nakachwa, a breastfeeding mother, had to sleep separately from her husband and avoid gardening. Some villagers ostracised her. To support recovered patients, the Ministry of Health and WHO deployed a specialist to assist psychiatrist Ruth Nakyanzi in reintegration efforts.
However, Dr Sendikadiwa believes more is needed. “Patients receive initial counselling, but follow-up support is lacking due to financial constraints,” he says. In Mpox-free Mayirikiti Town Council, Health Inspector Julius Waibi credits vigilant VHT members for keeping the virus at bay.
Strengthening infrastructure
The world remains vulnerable to viral outbreaks. While Covid-19 has subsided, new variants continue to emerge. The 2022 Mpox outbreak underscored the need for better preparedness. The 2023 Marburg virus outbreak in Tanzania further highlighted containment challenges. Other viral threats, such as dengue, chikungunya, and Ebola, continue to strain healthcare systems. Dr Sendikadiwa stresses the need for permanent isolation units. “Health facilities are under-resourced. Even beds are scarce, so we prioritise general patient wards. We lack trained outbreak response staff, relying instead on those with Covid-19 experience. Each district needs at least one isolation unit,” he says.
