Dr Loyce Faith Nangiro, a medical officer at Amudat Hospital, in Karamoja, Northern Uganda, has been treating patients with visceral leishmaniasis (also known as Kala-azar) for four years now – but few would guess she was never meant to go to school.
As a child, Nangiro’s family expected her to be the family’s herder and later be married. ‘I was supposed to take care of our animals My father made it a point that I shouldn’t study, and even though I saw other children going to school, I wasn’t allowed to,’ she recalled.
At age five, she showed a rebellious streak and secretly enrolled in a nearby primary school and began attending classes. By the time her father found out, it was too late to pull her out. The young Nangiro finished primary school but couldn’t afford to attend high school. Fortunately, a well-wisher stepped in and paid her school fees. But finishing high school was not the end of the road for her – nor the end of her drive to beat the odds.
Nangiro set her mind on going to university and becoming a doctor, but her family had other plans and arranged a marriage for her.
‘No one saw sense in me going to university for a five-year course, yet here I was telling them I wanted to be a doctor. My village had never seen a female doctor. So, there were already cows for the dowry prepared, and meetings had already happened. But I went against their will and told them I wanted to study. I wanted to be the first doctor here and inspire other girls.’
‘I had to fight with the relatives who sat me down to explain why marriage is better and how I was preventing them from getting cows for us. In my community, they groom us for the bride price. But I stuck to my word, and of course, that came with repercussions. I didn’t have someone to take me to the university, but that didn’t stop me from applying for scholarships here and there, as well as private scholarships,’ she said.
Nangiro received a private scholarship to pursue a bachelor’s degree in pharmacy, but it was not the course she truly desired. She approached the university to request a change of course. ‘I told them that if I did pharmacy, I’d work in the cities, but if I did medicine, I would serve my community where I am much needed. The university was kind enough to admit me for Bachelor of Medicine and Bachelor of Surgery. And fortunately, God blessed me with Juliana Amal and Dr Violah Nyakato who supported me with tuition,’ said Nangiro.
After five years of studying, Nangiro graduated as a doctor and secured employment shortly after in Mbale City. But only ten days into the job, she chose to resign.
‘Everybody thought I was crazy. The pay was good; the working conditions were okay. But it wasn’t serving my passion. I was working in a private setting where I was seeing all these well-off patients who had the luxury of choosing the specialists they wanted to attend to them. Yet, where I came from, you had to be very lucky to even see a general doctor. So, I resigned and came to volunteer in Amudat Hospital,’ said Nangiro.
A fortuitous meeting
For Nangiro, Amudat was not an ordinary village hospital. It held a special place in her heart. Years before, when she desperately needed assistance, an Amudat hospital vehicle came to her rescue.
‘When I was 16 years old, I was stuck in Mbale city as I returned from high school, about 100 kilometers from my home. I saw a vehicle with Amudat Hospital Kala-Azar Project written on it. I didn’t know what kala-azar was, but I knew the vehicle passes through my district so it could take me home,’ she said.
Dr Patrick Sagaki was one of the people who offered to give her a ride back home in the hospital vehicle. Although Nangiro did not see him again for years, the two would meet again at Amudat hospital.
‘When I qualified as a doctor, I planned to pay a courtesy visit to Amudat hospital, to come and volunteer for about a month without revealing who I was, and after one or two months, say thank you for the lift. But when I came here, I saw that there was an actual need.’
According to Nangiro, the demand for services exceeded what the clinical staff could provide, especially in the maternity wards. Dr Patrick Sagaki was alone in the hospital and Nangiro saw an opportunity to fulfill her passion and put her hard-won education to good use. Nangiro stayed – and Sagaki became her supervisor.
Besides being driven by the need to help her people, Nangiro also wanted to inspire the young girls in her community.
‘I wanted the parents to see the value of educating a girl child. So, when I came back and saw all these young girls having babies – I was operating on some of them – I knew I needed to do something. I go to the schools, talk to the young girls and encourage them to study. Sometimes, I receive support from friends who give me sanitary pads and other school items that I take to the girls.’
Nangiro’s efforts are paying off as parents now see her as a positive role model for their children.
Improving access to treatment
During her time at university, Nangiro recalls leishmaniasis was briefly mentioned, but they were provided with few details about the disease.
‘All I remember is they said it’s in Amudat district in Karamoja. Nothing much, nothing about treatment, and I did not see a patient. When I moved here, I saw that this hospital was a center of excellence for kala-azar and offered mentorship. I started to learn more about kala-azar and treating the patients.’
Coming from the area and being fluent in the native language allows her to communicate effectively with the patients, including village health teams who had limited knowledge about the disease’s presentation and treatment. Nangiro bridges the gap and facilitates training to address this issue.
When Uganda’s Ministry of Health, with funding from the END Fund, supported activities to build the capacity of health workers and village health teams in leishmaniasis detection, screening, and access to care in her region, Nangiro was keen to get involved.
‘Through this programme, we empowered 137 health workers and 192 village health teams from selected health facilities in the Karamoja sub-region. This has raised awareness, facilitated early detection, and improved access to care – improving the prognosis for many patients. With these interventions, the total number of admissions increased from 132 in 2020 to 340 by 2022.’
‘Now, we have trained the health workers across the different districts of Karamoja. They can identify kala-azar. They can test and screen. And they reach out to us when the screening is positive. So, the patients come sooner, we initiate treatment earlier, and we are reducing the mortality rate.’
Although progress has been made, Nangiro continues to encounter some challenges at the facility.
‘Some patients still present late, and the duration of treatment is 17 days. That’s a long stay for some parents as they have other children at home and need to see to other things, like their farming activities. Most times, I must talk them into staying in the hospital for 17 days until the patient gets well. But we pray that the treatment time is reduced with better medicines,’ she explained.
Looking towards the future
With her Little Faith Foundation, Nangiro aims to provide school fees and necessities to more girls in her community. As for her medical career, she plans to pursue a master’s degree in pediatrics, followed by public health and research.
In the meantime, she’s looking forward to participating in her first DNDi clinical trial for leishmaniasis at Amudat Hospital.
Photo credit: Dr Loyce Faith Nangiro
