Hope Ward, Kampala

(Please Note: A full profile of Dr. Ian Clarke appears in, One Wild Life. Available now in all good bookshops)

“Just because a country is third world, it doesn't have to be third rate”, said Dr. Ian Clarke, founder of International Hospital Kampala (IHK), which rises tall above the Namuwongo district of Uganda's capital. His words, rich with a Northern Irish accent, almost echo through the wards he founded back in 2004. Looking around, third rate is certainly not on offer here. The building's architecture is deliberate, its surfaces clean; not words readily associated with medical practice in the country. 

It was a distinct lack of services which drove Clarke to establish the hospital in the first instance. His aim was to raise the bar on medical practices across Uganda, causing a ripple effect in the quality of health services available and forge new intersections between public and private health provision.

Now, just a few years on, he has set up a private hospital and insurance company and with the profits and partnerships is able to use the resources to run a charity ward and outreach clinical services across the country. This is ripple effect: writ large. 

But meeting Clarke it is initially hard to imagine that he has the energy within to drive such an immense project. His frame is lighter than slight; his look bordering on gaunt. Doubts though are jettisoned when we actually get into conversation. We had arranged to have lunch together and ordering a meal he is immediately insightful and remarkably quick. He orders so quickly in fact that the waitress hardly has time to call out the specials. And while his speed could be interpreted as abrupt, his undeniable charm and quick wit bring him back to courteous. One thing is very clear: he knows what he wants. 

It is a sense of vision and clarity which has driven him away from his native Bangor into post-war Uganda, arriving first in 1988 with his wife, Robby, and three young children. Uganda at the time was still reeking with Idi Amin's legacy, and things were bleak. “It was like nothing had happened since the war”, Clarke recalled, “there were still all the skulls and eerie silence, and I could see all this medical need”.

Responding to those needs, and putting his medical skills into practice, Clarke first set about establishing Kiwoko Hospital in the Luweero district of the country. His unorthodox methods at the time have already been recorded in Uganda's national press: establishing the first clinic under a tree; transforming a local church vestry into an examination room and enlisting a lay preacher as a medical assistant. And, as a matter of course, Clarke himself would be out with hammer and nails building and constructing. “I'm from a farming background and I am used to doing things”, he explained, as if that was a legitimate reason, “I'm the sort of person who needs to see what I do”. 

It was that same practical hand which geared him away from GP medicine in Northern Ireland in the first place. Having practiced medicine for a few years following graduation, he soon became restless. “Basically I was bored and wanted a challenge”, he recalls. Realising that he probably should have gone down the surgical route of medicine, Clarke instead decided to go into business, first with bookshops, then furniture shops. However, when an opportunity came up to visit Uganda, he seized it, packing up shop at home. A two week visit turned into two years, and two will soon be twenty. The challenge simply got bigger. 

But the ride along the way has not been easy and a big buckle came when, just as Kiwoko Hospital was under steady heel, Clarke was diagnosed with cancer. Returning to Ireland for treatment, he saw the scans himself and knew the outlook was far from promising. “For a week I was totally sure that was the end of my life” he recounted, “so it was a very interesting week!” Emerging from an intense course of therapy, he arrived at the other end even more determined. “I felt had all this experience of working in a post-war situation, with the rural poor, with HIV/ Aids, and a near death experience myself. Why would I waste all that?”

And so Clarke returned to Uganda, setting up the International Medical Centre and later IHK. “I decided that my goal was to start a hospital in Kampala and to raise medical standards. This time, instead of targeting the rural poor, where we had been working, I would target the emerging middle income group and use the money that they pay to upgrade the services so that we could get a better level of service, and so effect the overall delivery of services”.


After lunch we returned to the hospital. It was an opportunity to see firsthand how some of those services were manifested, as Clarke took me on a quick spin of the wards. ‘Quick' again being an appropriate choice of adjective - it was hard to keep up at times. As we twisted in and out of wards he greeted staff and patients with equal flurry, “Still riding that motorbike, Alan?”, “Where are you off to Irene?”, and as we passed the paediatric unit, calling out in an air of childlike glee, “Great news that those babies were well enough to be discharged”. Two premature babies had made it through healthy that morning, the empty incubators standing as emblems of success. 

As we continued to the wards, I met one patient who was suffering from elephantiasis, complete with the tell-tale swelling of the lower limbs. The sight of his grossly enlarged leg is not one I wanted my camera to record, but the memory of it is a reminder of all that medical need which Clarke earlier spoke about. I must have concealed my faint-headedness well, for passing the main reception he took out an album of case studies, each double page devoted to before and after pictures of patients. Facial reconstructions, tumour removals, burn wounds, AIDS patients, more elephantiasis, more tumours. The young, the elderly, the middle class, the poor, the poorer. And while my stomach did Olympic-sized churns over the sight of the ‘before' images, the stories from the ‘after' were enough to fill me with optimism.

With no time to pause, the tour of IHK continued apace. Soon we are on the top floor where Clarke checked up on the construction progress in new university teaching rooms, part of the International Health Sciences University which IHK have just established. With a smell of wet paint lingering, I picked up a brochure for the new academic term; the list of courses on offer making for impressive reading especially knowing that the first intake of students was just a few weeks away.

On our way back down the wards, we paused at the entrance to the Hope Ward, the charity wing of the hospital, funded in part through profits from the main hospital and the remainder through corporate sponsorship. The ward looks no different from the private ones; clean and as well staffed as the rest. Here, patients who are in need of the services but unable to afford them are referred. Many come from the conflict zones in Northern Uganda to avail of reconstructive plastic surgery. Others come by way of charities and orphanages who know of IHK's services, and realise that the likelihood of quality care in the main government hospitals is limited. 

Outside the Hope ward, a notice board with media clipping is like a trophy cabinet: ‘International Hospital help poor get treatment'; ‘Hope ward renews joy in living'; ‘Uganda performs six heart surgeries'. The clippings are alongside a poster advertising free cleft pallet surgery. As I pass by it, the international air ambulance, part of IHK's emergency service, takes to flight from one of the ‘H' pads outside. Children rush to the windows to see it lift off. The noise is almost deafening, the enthusiasm palpable.

Impressive as all of this is, I am aware that what I'm seeing on the hospital's Namuwongo grounds is only part of IHK's overall project. Outreach clinics are also spreading throughout the country, to places as far away as the northern regions of Pader, Lira and Gulu. One clinic is on a flower farm, another at a factory. They are joint initiatives with private sector companies who want clinics locally for their staff and families to access. The companies ask IHK to set up services and contribute to the running costs. The clinics can then become a base to reach out to others in need in the community who otherwise would be unable to access local care. Clarke explained that such joint ventures are integral to their expansion plan and their mission to raise medical standards nationwide, “It is all part of trying to leverage our expertise”. 

But growing such a monumental project- from the hospital, the insurance company, the clinics, the university- and all at the same time, is not without its significant challenges. Funding, resources and management capacity has taken time to build. The construction materials needed to be sought. Curriculum needed to be developed. New systems needed to be implemented and people educated in using them effectively and efficiently, all the while building enough capital and infrastructure to keep it all sustainable. Finding good staff to do it all, and retaining them, has also been a difficulty, Clarke explained. While the new university aims to create a cadre of highly qualified medical professionals in the county, it will be years before the first batch is qualified and experienced enough to fill all the gaps needed to meet IHK's wildly ambitious targets. Turning to the likes of India for specialised staff is looking like one of the only viable interim measures, which Clarke realises is not ideal.

But aside from management and expansion issues, there have also been more sinister challenges. With a darkened mood and obviously frustrated, Clarke explained that money has been stolen by several trusted staff and valuable time wasted in bringing the cases to court. For a man who is known for his belief and investment in people, it would be hard not to be shaken, and the look in his eyes tells me that he is. But with 500 current staff, he knows he has to keep going. “There is no way back, I have come too far”, he says, adding after a lengthy pause, “I have learned that you don't give up but you don't expect to make huge strides at once. You just keep going through them incrementally. Then you look around in a few years and say, oh yes, we have made some progress”.

If ever in doubt of the progress, he should take comfort from the walls of the hospital itself. A mural painted by some children in the Hope ward, in bright, sunny colours seems to say it all: ‘Don't give up', ‘Life is worth'. ‘Tears of Joy', ‘Life is good'. I'm not sure if Hope Ward was named as an aspiration, but it is clear that for many, hope has indeed taken root. And just as I was leaving, the air ambulance once again took to the skies, the children's cheer lifting out of the windows with it.

(This article first appeared on SpunOut.ie. Thanks to the Simon Cumbers Media Challenge Fund for supporting this work).