Working with refugees in Uganda: how epidemiology can make a difference

Palorinya refugee settlement in northern Uganda has become host to approximately 147,000 South Sudanese people since renewed conflict broke out in July 2016. Sam is a public health physician who has just returned from the settlement, where he's been helping MSF to understand the health care needs of the community.

I’ve just finished an assignment setting up an emergency community health surveillance system in Palorinya refugee settlement, northern Uganda.  

Close to 150,000 South Sudanese refugees have settled in Palorinya over the last few months, fleeing conflict and violence.

In acute emergencies like this, when large communities are in chaotic new environments and new countries, it can be very difficult to understand their health status, but working as an epidemiologist, it was my role to build this understanding to shape MSF’s response. This is vital, as it means MSF can make informed decisions about what’s needed most, getting the right staff and equipment in place as quickly as possible.

Sam and some of the team! Photo: Wairimu Gitau / MSF

When I arrived in February at the height of the displacement, it was overwhelming even to imagine where to start with establishing any kind of system to record health issues in a place like Palorinya. It was a big task but we trained a team of over 100 surveillance officers and by mid-March the team had managed to visit over 10,500 households and interviewed over 41,000 people.

“Without that visit, it’s unlikely that her death would have been recorded anywhere”

Household interviews are a really important part of our data collection work, as we can build a better understanding of people’s lived experiences and needs, rather than only reaching those who are able to visit health facilities.

When one of the community surveillance teams was on a routine household visit recently, they learnt about a woman who had passed away. Without that visit, it’s unlikely that her death would have been recorded anywhere, and we wouldn’t have known about her illness.

From speaking to her family, our teams found out that she had developed yellow eyes and symptoms consistent with a hepatitis infection before her death.

Displaced populations such as the refugees here, who are having to live with poor hygiene and sanitation conditions, are particularly susceptible to outbreaks of hepatitis E. This means picking up on potential cases is important to reduce the possibility of more infections, more sickness, and more deaths.

As a response to hearing about the woman who had died, we intensified data collection in that area, looking out for any symptoms which may indicate a hepatitis infection, and our team set about sharing key health promotion messages around hygiene and sanitation to reduce the risk of it spreading.

Identifying women’s needs

The team collects information about people’s health through weekly household interviews, while also collecting medical data from health facilities in and around the settlement. Through this data we are able to detect trends and changes in the health of the people there, and can respond better as a result.

In my last few weeks in Uganda, surveillance teams identified several stillbirths, neonatal deaths and a maternal death within one area of the settlement. We could see that women there were facing challenges accessing sufficient care during and after their pregnancies. Knowing this, MSF has expanded women’s health care services to these areas. 

It’s been great to see how our health surveillance system is helping, and hugely gratifying to see the interaction between the community and MSF in shaping emergency response. I feel lucky to have been here, to establish emergency surveillance from the start of an intervention, and to see it working.