Q & A with Ronnie Mayanja — Dr. Nandawula Kanyerezi Mutema, M.D. is a Diplomate in Internal Medicine, a certified member of the American Board of Internal Medicine and the Executive Director/lead Physician at Clinic at The Mall. She is married to Dr. George Kimbugwe Mutema, M.D. and together they are the proud parents of Tendo Bajjide Mutema, a student at St. Paul’s School, Concord, NH). Prior to my departure from Uganda last month I visited Dr. Nandi’s clinic and was able to experience this new facility first hand. We now bring you our Q&A with Dr. Nandawula who returned from Cincinnati, Ohio were she had lived for many years. Below are some answers she gave us on what inspired this vision for for a state of art healthcare facility in one of the upscale suburbs of Kampala.
Occupying 4000 square feet in a newly built upscale mall in Bugolobi. The clinic is outfitted with Digital X-Ray, 3D Ultrasound, Digital Mammography, CT Scan, Echocardiography and a Full Analytical Lab. In seeking to decrease their carbon foot print, 75% of the energy needs at the clinic are met by solar energy. The utilization of an electronic medical record allows for ease of sharing patient records with other practitioners when patients are referred. The clinic is currently staffed by 2 physicians certified by the American Board of Internal Medicine.
1. What made you go back home and open The Clinic at The Mall?
October 2013 was the turning point for me. It was time. I decided I needed to go back home. I had studied, worked and lived in the US for 21 years. I came to the US in February 1992 having graduated Medical School the year before, and completed my internship the month before I travelled. I had worked at The Health Department City of Cincinnati for over 17 years as a Primary Care Physician. It was time for me to go back home, to utilize all the skills I had learnt to further health care at home in whatever small way I could. Thus the dream of The Clinic at The Mall began. I remember telling my husband George about this that Sunday seated in the living room at home with our partner Ivan Lubogo. The support I got from both of them was indeed overwhelming. My question to them that day was, if you wanted this all along, how come none of you had said so before? They said it was a decision I had to come to on my own, but they were there to support me and the three of us ran with it.
2.How long have you been practicing Medicine in the US, and what is your field of practice?
I am a board certified Internal Medicine specialist. I have been practicing in the US for the past 17 years as a Primary Care Physician at The Cincinnati Health Department. Unlike many cities, The City of Cincinnati provides medical care for its residents that are uninsured or under insured. It has several Primary Care Health Centers in the neediest neighborhoods.
3.What specific healthcare services are you providing at The Clinic at The Mall and how different will this clinic be from the rest?
The Clinic at the Mall is a comprehensive primary health care center. A one stop shop if I may. We will focus on diagnosing and treating acute and chronic illness while emphasizing preventive medicine and the overall health and wellness of our patients. We seek to engage the patient in their care knowing that it improves outcomes. The Clinic is currently staffed by 2 physicians as well as highly qualified nurses and support staff. We have on site diagnostic services including:
Echocardiography and Cardiac Stress Testing
Full analytical Laboratory
The keys to our success will be:
Focusing on patient care
Educating our patient on the importance of preventive medicine
Educating our patients on the importance of the annual exam
Establishing a sound relationship between the patient and the medical practitioner
Assuring ease of accessibility to care for all our patients.
4. What can you say about the issue of cost vs healthcare insurance?
Health care in Uganda is at the precipice of change. More patients have insurance provided by their employers. We are working on enrollment with all the insurance providers national and international available in Uganda.
5.What diagnostic procedures will you perform at this facility? As an outpatient facility will you accommodate minor surgical procedures on site?
Other than providing medical care, we have a complete radiology department. We are partnering with Columbia Asia Tele radiology Group who will be reading all our imaging studies. We are also working on a partnership with a group of Radiologists locally who will be doing interventional radiology like Ultrasound and CT guided biopsies where needed.
We are in Consultation with a Cardiologist and a Pathologist in the US whom we consult with regularly and are looking to engage with more sub-specialists in the diaspora.
6. How many doctors, nurses and ancillary staff will this facility bring on board?
We currently have 2 physicians. We are both Diplomates in Internal Medicine certified by The American Board of Internal Medicine. We have 2 well qualified nurses with Diplomas from The Aga Khan University here in Kampala. We have a Radiology Technician and several administrative staff.
7. What will be your hours of operation and will the facility be working with any International referral hospitals?
We are currently open 9:00 AM to 6:30 PM Monday – Friday, and 10:00 AM to 5:00 PM Saturday.
The Clinic at The Mall as noted above is in collaboration with the Radiology group at Columbia Asia Hospital in Bangalore. We are looking to further that partnership with them as a referral center for the patients that may need medical services that we are not able to provide in Uganda.
The Clinic as noted earlier is eager to establish relationships with various medical sub specialists in the diaspora with whom we can consult on a daily basis. This has proven to work well where we have been consulting with Dr. Moses Kyobe a Cardiologist in Oswego New York. We send him EKG’s, Echos and Consults online, and he renders his advice the same way. Our Pathology is done by Dr. George Mutema in Cincinnati, Ohio who has a Histopathology lab here in Kampala where the slides are prepared, sent to him by courier and in 3 to 4 days, reports sent back electronically to aide in better management of our patients. Such partnerships are possible across many subspecialties and we look forward to exploring them as we go along.
8.In a country with rising cancer cases and no preventive care, what are you doing to address this state of affairs?
It is our goal at The Clinic to engage our patients in their care and to educate them on all the necessary health maintenance procedures appropriate for their age.
All ladies over the age of 21 will need to get their annual Pap smears done, this is to aide in the early diagnosis and prevention of Cervical Cancer. We will be using the thin prep method which is a better tool.
Over the age of 40 years, we will encourage all the ladies to have an annual mammogram. This aides in the early detection and diagnosis of breast cancer which is indeed on the rise. The clinic as noted earlier has a Digital Mammography machine which yields good images and in collaboration with the radiologists in India, will be a great asset in women’s health.
Over the age of 50 years, all patient will need to have their first Colonoscopy which helps in the early detection and prevention of Colon Cancer. We have partnered with Dr. Moses Galukande here in Kampala for this procedure.
PSA measurement over the age of 50 for all the gentlemen will be encouraged.
The ills of tobacco use and other cancer prevention issues will be discussed with the patients on a regular basis.
Where necessary we will work with The Cancer Institute and Columbia Asia Hospital to effectively treat cancer if it were to develop.
9. Any special arrangement for diaspora interns to train or specialized doctors on holiday to work at the clinic?
Yes, we would love to be a center of excellence where Medical students, Interns and residents in the Diaspora can come for the experience. Not being attached to a University though, it might not earn them credit depending on what their institutions are looking for. As noted previously, working with various specialists in the diaspora is important to us and is welcome.
10. Finally, when is the grand opening and how has the Ministry of Health and other government regulators responded to your facility?
We will be honored to have The Minister of Finance, Hon. Maria Kiwanuka here with us this evening February 3, 2015 for the Grand opening. It is an exciting time for George and I and our partners as we see the culmination of 15 months of hard work in setting up this state of the art health facility in Kampala. It is an achievement we would not have attained were it not for all the advice and help we have received for which we are grateful.
How can someone contact you for an appointment or to learn more about the Clinic at the Mall.
Our contact number is +256 392 177283, after hours calls will be answered by one of the physicians and medical advice will be given based on the need. The clinic will cater to patients with and without insurance.
Our physical address is — The Clinic at The Mall, 2nd Floor, The Village Mall, Plot 47A Spring Road, ( P.O.Box 9003) (Behind Shell Bugolobi) Bugolobi, Kampala, Uganda. Contact +256 392 177283
Below is the full Speech By Dr. Nandawula – As presented during the Grand Opening of The Clinic at the Mall.
Honorable Minister, Rtd. Archbishop, Asst Bishop, Distinguished guests, ladies and Gentlemen,
It is my distinct honor to welcome you to the grand opening of The Clinic at the Mall. As stated by my husband and partner George, this has been a long time coming but it is here. We are grateful to the Lord for without His blessings, guidance and wisdom we would not be here.
The clinic seeks to be your medical home, and will provide high quality primary health care to all that come through its doors. What is Primary Health Care, and who is a Primary health care physician? Both Dr. Maria D’Arbela and I are Diplomates in Internal Medicine Certified by The American Board of Internal Medicine which means we specialize in the care of the Adult. As Primary care Physicians, we are like the Conductor of an Orchestra. The Orchestra has many instrument groups, all capable of producing brilliant and beautiful music on their own but together, they produce even better and more brilliant music that is pleasing to the ear. If any one of the groups, or even just one of the instruments is not played well or not in tune, the sound is unpleasant. The conductor must know about each instrument, may be able to play some of them but not as well as the musicians playing the instruments themselves.
His or her knowledge and command allows him or her to create this beautiful piece of music by keeping everybody in tune with each other, and knowing when to bring in one part of the orchestra or another. Each musician in turn listens to the other and pays close attention to the conductor. Likewise the Primary Care Physician knows when to call upon the various specialists and sub specialists in the medical field when he or she knows their patient needs their care. When at any given time a patient is being seen by more than one sub specialist, the primary care physician should be able to coordinate that care, and advise in order to avoid duplication of care or in the worst case scenario drug interactions that could be detrimental to the patient. The Primary Care physician is the practitioner who ought to get to know you well while you are healthy which thus makes it easier to evaluate and manage your medical problems when you are unwell. It is the duty of the Primary Care Physician to screen you on a regular basis to avoid or catch disease in its early stages where it can be better managed. The Primary Care Physician is your personal educator on all things medical and should be challenged to explain again when one does not understand. As your Primary Care Physicians, we promise to seek a second opinion when we are not sure what is going on. That in the medical field is not a sign of weakness but a sign of strength. A sign to you the patient that your health is of the utmost importance.
At The Clinic at The Mall, emphasis as noted will be on health maintenance. This we can only do if one comes for their annual exam where various test depending on age and sex are done. Annual labs done in our full analytical lab. Tests like the PAP smear which we will do using the Thin prep technic which gives us a better yield and result, Mammography which should be done annually in surveillance of breast cancer which is on the rise. The Clinic is equipped with a Digital Mammogrphy machine which provides clear images that aide in this respect. Digital rectal exams and PSA tests looking for Prostate Cancer and referral for Colonoscopy in surveillance of Colon Cancer. The clinic is also equipped with a 4 slice CT scan and a 3D Ultrasound to further assist in diagnosis of disease. Management of Chronic disease like HTN and NIDDM is equally as important in avoidance of the deleterious vascular complications that can arise. The clinic will have a dispensary to service the pharmaceutical needs of our patients. We will assure that each and every one of our patients is fully immunized and up to date on their health maintenance goals. We seek to engage the patient in their care which we know will produce better outcomes than when they are not engaged.
We will consult with other physicians here as well as in the diaspora to provide good care to our patients with the hopes that they too will decide to return home. The small change each of us can bring to the delivery of health care here at home, will bring about the big change we all need.
I have mentioned Dr. Maria D’Arbela, the brave soul who when I contacted her and told her about the clinic, agreed to come work with me without reservation. For that I am grateful. Together she and I have assembled a great team of Nurses, Lab Technician, Radiology Technician and Administrative staff who thus far have represented the Clinic well. As we get our feet rooted and as the demand grows, we look to add to our Primary Care team Pediatricians and Obstetrics and Gynecology Specialists who fall under the Primary care umbrella as well.
I would not be standing here today but for the backs of those that came before me, some of whom are no longer with us but sure are looking down and feeling mighty proud. Our mother Gibwa Kanyerezi the rock in our family who did everything she possibly could that my siblings and I would get a good education in and out of the classroom, and that we did! Our father Prof. Bwogi Kanyerezi. Dad you have been the best example any one could ever have. Thanks for paving the way, for being the ultimate optimist and the biggest cheer leader in your own quiet way to George and I. If I can be half as good a physician as you are, then all will be well.
To our son Tendo, the grace with which you received the news that I would be moving home makes me so proud of you.
And to the love of my life George, Thanks for your support along this journey, I could not have done this without you.
It is now an honor for me to welcome a lady that symbolizes the grace of the ladies that raised us, a lady we looked up to as kids, and still do, the Hon Minister of Finance, Planning and Economic Development, Maria Kiwanuka. Thanks for being here with us today.
Special thanks to Dr. Nandawula for the access and exclusivity. On behalf of the Ugandan Diaspora Community we applaud your spirit of giving back to the motherland. All photos by Guilio Malfese and this article may only be reproduced with attribution to the Ugandan Diaspora News Online. See images below of some of the latest medical equipment you will find at the village mall clinic!