St. Mary’s Hospital Lacor

St. Mary's Hospital Lacor, Gulu, Uganda.

One of the best hospitals in all of East Africa is a sprawling complex in northern Uganda that treats more than 280,000 patients annually. Founded by an international society, Comboni Missionaries in 1959 as a 30-bed maternity unit, St. Mary’s Hospital Lacor has since grown to be Uganda’s third largest hospital – a de facto referral hospital - with a reputation for quality service delivery and for addressing the medical and social needs of the poor. Lacor Hospital is well respected for providing health care with a human face as well as for excelling in areas of specialized medical service.

Lacor, a private not-for-profit hospital, currently has 476 beds and operates three peripheral health centers in Amuru, Opit and Pabo, each with an additional 24 beds. The hospital employs 556 staff, of which 23 are medical officers of various ranks, and 269 are nursing and paramedical staff.

The hospital has experienced phenomenal growth, particularly in recent years, yet has always managed to respond to increasing and changing patterns of demand without compromising professional standards and core values. Key to this achievement has been an implicit strategy of continuous monitoring and adjustment, as well as a commitment to the development of its staff, reinforced by a set of core values reflected in the hospital’s mission statement. The hospital’s achievements are all the more remarkable given the instability and strife that has characterized northern Uganda for the past 20 years as well as some of the challenges that the hospital has been faced with - most notably the Ebola outbreak from October 2000 to February 2001, which took the lives of 12 staff members including the director designate, Matthew Lukwiya, as well as the passing away of the hospital’s founders and visionary leaders, Lucille and Piero Corti.

Since its founding, Lacor Hospital has earned a reputation for being among the best health care providers in the country. This is a perception shared by nearly all stakeholders, from government officials and local opinion leaders to the public at large. Among Lacor’s strengths are a dedicated workforce, functional infrastructure, committed partners and a good working relationship with local and central government. The hospital is also valued for the contributions it has made to creating employment and training opportunities, and for the provision of security and humanitarian assistance during periods of unrest in northern Uganda. Lacor was considered a safe haven during Africa’s longest running war. Professionalism, compassion, integrity and accountability are the shared values that are quickly transferred to every new member of the hospital.

Challenges Ahead

Uganda is plagued by health problems including high rates of malaria, HIV/AIDS, tuberculosis, malnutrition, infant mortality and maternal mortality. These health concerns are multiplied in the north because of the political unrest, including a higher HIV prevalence rate (9.1 percent) than in the south.

At Lacor, medical staffers are working diligently to keep up with the demand and safeguarding the hospital’s mission and reputation. With a five-year strategic plan now in place, Lacor is considering how best to:

• Maintain and improve service levels


• Clarify comparative advantages and complementarities within the larger health care delivery system, while retaining the capacity to respond to emerging needs


• Secure and sustain human and financial resources


• Determine the appropriateness of expansion and the introduction of new services, and


• Strengthen relationships and interactions with stakeholders and partners to ensure understanding, identify opportunities and secure resources.

Hospital Services Lacor is a general hospital offering a limited number of specialized services. The hospital has the following departments: Surgery - including a burns unit, ICU and orthopedics Obstetrics and gynecology Pediatrics - comprising general pediatrics, cancer treatment (Burkitt ward), isolation ward and malnutrition ward Medicine - general medicine and tuberculosis ward Public health Dental unit Radiology - X-ray and ultrasonography All of these departments are headed by specialists. Institutional Resources   Total Beds 476 Beds devoted to cancer care (Burkitt ward) 10 Staff Physicians (8 specialists, 15 general practitioners, 2 specialist expatriates) We also have 13 doctors currently undertaking internships 25 Nurses 140 Dedicated oncology nurses (3 pediatric specialist, 2 dedicated to Burkitt treatment, 2 palliative care nurses) 7 Oncologists   Medical 2 Radiation (but our unit has been closed since 2000) 1 Pathologist (on rotation from Pathologists without Borders. In the event of a gap in coverage specimens are sent to the Department of Pathology at Mulago Hospital, Kampala for processing and diagnosis) 1 General and specialist surgeons 3 CT Scanner None MRI None Radiotherapy machines   Cobalt radiotherapy unit (the possibility of reestablishing a radiotherapy unit is under discussion with the Ugandan Ministry of Health) closed down since 2000 Linear Accelerator None Patients PER YEAR   Outpatients 267,253 Inpatient admissions 37,371

Patients and family members enjoying the Ugandan sunshine while the hospital wards are fumigated.

Cancer Treatment

Lacor established a cancer treatment ward in the 1970s. Because of financial constraints and other unavoidable circumstances, the radiotherapy unit built for the ward was shut down in 2000. Presently, Lacor Hospital is focusing efforts on cancers that can be treated largely with chemotherapy, surgery or a combination of the two. Patients who require radiation therapy are referred to the radiation therapy department at Mulago Hospital in Kampala, where the Uganda Cancer Institute is also located.
While Lacor does have a hospital-based Burkitt lymphoma registry, there is only one population-based cancer registry in Uganda, also in Mulago Hospital, which collects data only from Kampala.

Cancer Prevention

Hospital officials are discussing whether to offer vaccination against human papilloma virus for cancer of the cervix. It presently performs pap smear screening and is planning to institute a second screening method: visual inspection of the cervix using acetic acid (VIA).

Mission Statement The Mission of the Hospital is to provide health care to the needy and to fight diseases and poverty for every sick person regardless of ethnic origin, social status, religious or political affiliation. The Hospital seeks to promote the access to health care for the weakest social groups, like women, children, people in destitute financial conditions, and people affected by chronic diseases. The Hospital advocates a comprehensive, integrated and sustainable action on health, including treatment, prevention and training of health workers.

Collaboration With INCTR

In northern Uganda, Burkitt lymphoma is endemic. Lacor Hospital is interested in joining hands with INCTR to implement INCTR’s treatment protocol for African Burkitt lymphoma. After an initial meeting with INCTR representatives at the AORTIC Conference, Lacor Hospital took part in discussions at the Burkitt Lymphoma Conference in Kampala in February 2008. INCTR sent an expert to the center to assess its sustainability in delivering Burkitt treatment in accordance with the INCTR protocol. Ethical approvals and other administrative processes are underway and chemotherapy drugs will be sent to Lacor Hospital with an anticipated start date of the program early in 2009.

Children’s ward.

Other Collaborations

The Division of Cancer Epidemiology and Genetics of the National Cancer Institute, USA, has established a collaboration with Lacor, the major aim of which will be to study the epidemiology of Burkitt Lymphoma, and in particular, the possibility that genes that confer resistance to malaria could modifying the risk for the development of Burkitt lymphoma.

The international organization known as Pathologists without Borders is helping Lacor Hospital by sending pathologists on a rotational basis to the hospital in order to assist in training and education of African pathologists and technicians and to assist in upgrading pathology services. This effort is assisted by the Italian province of Bolzano which is is also providing funding to re-equip the pathology laboratory and to support staff exchanges.

Graves of the hospital founders (Dr. Lucille Teasdale, a Canadian surgeon and her husband, an Italian, Piero Corti) and also of Dr. Matthew Lukwiya, Medical Superintendant, and other staff members who died in the epidemic of Ebola fever.