The mission hospitals in East Africa have many problems in common. However, Kagando, through it’s community programs, addresses problem solving in significantly different ways. First, members of the community are intimately involved in all aspects of program development. These include the identification of needs, development of means to address them, formulation of specific objectives to be achieved, establishment of budgetary and personnel requirements, methods of funding, and devising criteria to evaluate the projects’ successes and failures. Being designed with input from citizens and local councils, the projects have a high rate of acceptance and participation.

Second, programs are structured in a holistic manner. For example, malnutrition in children is so common that a section of the pediatric ward is solely devoted to its treatment. (Malnutrition, dysentery, and malaria are the most common causes of death in children under 5 years of age.) Treating the acute and chronic manifestations of malnutrition is not enough. The primary objective at Kagando is to prevent the same children being admitted again and again. To achieve this objective, a nutrition education program has been instituted for mothers and caregivers. Caregivers often outnumber mothers, because many children have been orphaned by AIDS. The program includes hands-on cooking sessions where the women learn how to prepare foods so as to preserve their nutrients. In addition, they learn which crops provide maximum nutrients as well as high yields when grown at home. Demonstration gardens on the hospital grounds facilitate the process. And, when the women and children return home, learning continues through community outreach and follow-up evaluations.

Third, it is significant that men and women in the community participate in hospital and outreach programs as volunteers. This is not only unusual, but very encouraging because Africans, for the most part, are not attuned to the concept of volunteerism. The majority of community health workers are volunteers. Their involvement fosters neighbor-to-neighbor cohesiveness, promotes grassroots communication and learning and results in appreciable cost savings. It should be emphasized that recipients of KARUDEC services are expected to pay money or in-kind as much of the cost of their care as possible. Often, this amounts to nothing or only a few hundred shillings. However, the payments add up and defray significant expenses. Without them, the organization could not survive.

Community input, holistic approach, and volunteer participation have been nurtured by the intuitive and farsighted management team at KARUDEC. Most have acquired their skills on the job and have intimate association with the people they serve. The managers, doctors, nurses, teachers, program directors, staff and students are sustained by their religious faith and commitment. They face what to us in the developed world seem insurmountable problems with meager resources. They combine the innate friendliness of the Ugandan people with persistence and compassion. They rarely speak about problems. Rather, they are constantly seeking the best possible remedies for the endless challenges before them.