Written by Dr. Gregory Bartha

Joel age 10 came to the Cross Clinic in the spring of this year.He complained of weakness and shortness of breath. He was small for his age and had a loud heart murmur. His lips and fingernails had a bluish color. The ends of his fingers were clubbed, meaning they were enlarged with downward sloping of the nails like an upside down spoon. Also he was frequently found squatting when he was short of breath.

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Written by Dr. Gregory Bartha

Here are pictures of two children suffering from cancer. The were initially seen and evaluated at the Cross Clinic then referred to the cancer center in Kampala. Both have been operated.

Suzan is 8 years old and presented with a bulging left eye. Scans revealed a tumor behind the eye pushing it forward. The tumor was successfully removed, but there is still prominence of the eye. There are changes in the structure of the skull which will require additional surgery to correct. The most common eye tumor in children is called retinoblastoma. The prognosis is good with over 90% 5 year survival. Surgery is the basic treatment. Radiation and chemotherapy can be useful in difficult cases.

The other child Alupo Gracious is 2 years old. She had a tumor called ependymoma at the base of the brain. It was compressing her cerebellum and blocking drainage of fluid from around the brain. The surgery was difficult. She is going to be left with some neurological damage. The prognosis for this type of tumor is about 80% 5year survival. In this case the location of the tumor will result in a poorer outcome.

We have seen a number of children with cancer at the Cross Clinic. The most common types of malignancies we have seen are lymphoma, cancer of the kidney and liver, and tumors of the bone (osteogenic sarcoma). The prognosis for these tumors is generally good, much better than the results of the most common adult cancers such as lung, breast, colon, and pancreas.

Some generous people in Midland have contributed to a fund which will help pay for treatment of these children with cancer. The Cross Clinic hopes to continue to assist in the care and treatment of these children. Each one is deserving of our best efforts.

If you are able to donate, please send all tax deductible donations to:

First Presbyterian Church
800 West Texas St.
Midland, TX 79701
Please include: Dr. Bartha Uganda Fund in the memo

Written by Dr. Gregory Bartha

A new operating room, or theater as it is called in Uganda, was opened and dedicated at the Cross Clinic on September 9 of this year (2021). The medical and administrative staff of the clinic, the District Health Officer, the District Commissioner, and other local officials were present.

The facility is well constructed and supplied. There are two operating beds, an anesthesia machine, sterilizer,oxygen, running water, and a prep room for the surgeons. There is a post op area and a dedicated nursing staff to care for the patients. It is the best equipped theater in the general area. The surgeons working there are graduates of Ugandan medical schools and are well trained. I have financially assisted several of these physicians in their medical education.

The local officials were very impressed with the new theater and indicated that they may give some financial support in the future though this is doubtful. Currently most of the surgeries performed are for hernias, hemorrhoids, abscesses, and superficial tumors. We hope to be able soon to perform hysterectomies, treatment for osteomyelitis and complicated bone fractures, and cataracts. These services will be of great benefit for people in a wide area. We also plan to invite surgeons from the U.S. to come and volunteer their services at the facility.

I will stress that the theater was largely funded by generous Midlanders in cooperation with 1st Presbyterian Church of Midland.

Tax Deductible Donations to support Dr. Bartha and the Cross Clinic can be mailed to:

First Presbyterian Church
800 West Texas St.
Midland, TX 79701
Please include: Dr. Bartha Uganda Fund in the memo.

Written by Dr. Gregory Bartha

Another great inspirational figure in African history is Dr. David Livingstone.

 He was born in 1813 to a poor Scottish family. At age 10 he had to go to work in a cotton mill ten hours a day, but he attended night school and mastered Latin and Greek. At age 20 he resolved to become a missionary and devote his life to the alleviation of human misery.

 He attended college classes in Glasgow frequently walking the seven miles to school and back each day. Later he was accepted by the London Missionary Society. He completed his medical education then studied theology. He wanted to be sent to Asia, but there was political strife in China at that time, and he was posted to South Africa.

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Written by Dr Gregory Bartha

Most people in Uganda are of normal weight, and many are very thin. This is because their diet mainly consists of corn cassava, some beans, and occasionally chicken and pork. Also people tend to be very physically active doing a lot of walking and manual labor. Western style food is making some inroads in Kampala and the smaller cities, and along with this change comes more obesity and then diabetes.

This form of diabetes is termed Type 2 and can often be controlled by diet and oral medicines. Eventually insulin may be required. There is also Type 1 diabetes in which the body makes antibodies which attack and destroy the cells in the pancreas which produce insulin. Insulin injections are necessary to control this type.

A 15 year old boy came to the Cross Hospital complaining of weakness, weight loss, and constant thirst. His blood sugar (glucose) level was 500, normal being 80 to 120. We told him that he had the form of diabetes which required insulin. He was reluctant to start the injections. We talked with him at length about the nature of his illness and that his health would continue to decline if he did not take insulin. He went home to think about it. A few days later he returned, and we admitted him to the hospital, started checking his glucose levels several times a day, and introduced insulin.

His treatment was challenging because in Uganda there are only two types of insulin available – a short acting kind which reduces the blood sugar rapidly and a mixture of the short acting and a long acting form which lasts i2 hours or more. Ideally patients with Type 1 should be given a long acting acting insulin by itself once a day and injections of short acting before meals. Using only the mixture does not control the blood sugar well and can cause the sugar level to go too low and cause a person to become confused or lose consciousness altogether. For this boy we gave him the mixed insulin twice daily and gradually got his sugar down to around 200 most of the time. Ideally it should be 150 or below most of the time. The boy started to feel much better with more energy and less thirst.

We gave the boy a glucose meter and strips and taught him how to check his sugar level and how to make adjustments in the insulin dose. We told him to keep good records of the glucose levels and the insulin dose. Also we emphasized that he must never run out of insulin. He would become very ill quickly. Fortunately insulin does not need to be refrigerated after a vial is opened, and the syringes and needles for injection can be used several times.

He needs to be checked regularly at the hospital so his records can be reviewed and adjustments in the insulin dose can be made. This program is very difficult to carry out in rural Uganda and requires the combined efforts of the family, the boy, and the hospital staff. This a lifetime work for this boy who also faces the many other challenges of life in rural Uganda.

Written by Dr. Gregory Bartha

The Ugandan government has made women’s rights and employment opportunities a high priority. There is a national holiday to honor women. Women hold many high government offices including directorships of a number of ministries and the positions of Prime Minister and Vice President. The President’s wife is very active in government. Each of the districts in Uganda elects a woman member in Parliament in every  5 year election cycle.

Girls’ education is emphasized but there remain many obstacles in the rural villages – lack of parental support, early marriage, and poverty. Many girls leave school when they start to menstruate. They have no menstrual pads and are ashamed to show that they are bleeding.Pads which can be washed and reused for up to one year are made in Uganda. The organization I work with has purchased and distributed these pads to girls at school. The girls and the schools are very pleased with this program. Poverty also creates problems for girls. They may accept offers to trade sex for money to help their families. In the recent lockdown periods many girls have become pregnant. Some have tried to abort themselves resulting in miscarriages and serious infections.

I help to support a vocational school which serves young women who never advanced in their education because of early pregnancy. They are trained in hairdressing, tailoring, and early childhood development so they can be nursery school teachers. With these skills they can support themselves and their children. In addition I have provided scholarships for many girls to attend secondary schools, colleges, and universities. Clearly the greatest challenge to overcome is poverty.

Tax Deductible Donations to support Dr. Bartha and the Cross Clinic can be mailed to:

First Presbyterian Church
800 West Texas St.
Midland, TX 79701
Please include: Dr Bartha Uganda Fund in the memo.

Written by Gregory Bartha

In an earlier blog I mentioned that Albert Schweitzer was the inspiration for my work in Africa. He was born in 1875 near the border between France and Germany. There is a story that one day a boyhood friend invited him to go with him to shoot birds with a slingshot. Albert had to leave because he could not stand killing another living creature. He attended village schools and made a decision in late adolescence to someday go to Africa as a doctor to help the people there. He went on to university and studied in both Paris and Berlin. He wrote a series of books on the life of Jesus which gave him a worldwide reputation in theological studies. He was also a gifted organist and wrote a definitive work on the life and music of Bach.

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Written by Dr. Gregory Bartha

The Cross Clinic is located in the small village of Katekwan in the northeastern part of the country. It is about 45 minutes out of Mbale, a city of 100,000 to 150,000 and with a surrounding population of 500,000. Mbale is the regional center for processing and transporting agricultural products.

We remodeled an abandoned guesthouse (a small hotel) to form the clinic. There was no running water, and electric power was intermittent. A pit latrine was in the back. The lab was equipped to perform a few basic tests, and the pharmacy had a supply of medicines needed for common medical complaints.

I worked along side Luke, a clinical officer – same as a Physician Assistant in the US. He was quite skilled in diagnosing and treating common medical conditions.Malaria was the biggest problem. It is  widespread in Uganda because of the large number of swamps. As you probably know, it is caused by a parasite which is injected into the bloodstream by a mosquito bite. Children from 6 months to 3 years are most commonly infected, and most deaths occur in this age group. It is best diagnosed by using a microscope to see the parasites in a blood smear. If microscope or electricity is not available, there is a rapid diagnostic test using a small device and a drop of blood from the patient.

Just recently trials have been completed on a new malaria vaccine made in Oxford, England. Reports say it is 75% effective in preventing the disease.This vaccine should be available in one to two years and will greatly reduce the burden of disease in Sub Saharan Africa. Until the vaccine is available the best practices to prevent malaria are to sleep under a mosquito net treated with insecticide, eliminate standing water near homes, keep bushes trimmed short, and avoid outdoor activities at night.

Other problems seen frequently at the clinic are diarrhea, pneumonia, wounds, skin infections, abdominal pain caused by ulcers or pelvic infections in women, and a variety of bone and joint conditions. We refer more complicated medical problems and surgical conditions to the regional hospital in Mbale. The regional hospital is well staffed but poorly supplied. The patients are often asked to purchase antibiotics, IV fluids, bandages, and skin cleansers for their treatment.

Written By Dr. Gregory Bartha

Goiter is a fairly comm0n condition encountered at the Cross Clinic. Some of the goiters are quite large and at times cause difficulty swallowing and breathing. Certainly most of the people are concerned about the appearance of the growths. The vast majority of the goiters are not malignant, but some contain small nodules which could develop into cancer at some point in the future.

Goiters most commonly develop because of a lack on iodine in the diet. In Africa many of the people buy salt in a local market, and the salt doesn’t have any added iodine. In the U.S. all of the commercial salt has added iodine. Fish is also a source of iodine, but Uganda is a land-locked country, and most people consume fish only rarely.

Most persons with goiter have normal thyroid function, but some have too little thyroid hormone, and some have too much. Persons with low levels of thyroid hormone frequently report cold sensitivity, dry skin, constipation, fatigue, and weight gain. Thyroid hormone is available in pill form which can correct the symptoms. Persons who have high levels of thyroid have fast heart rate, sweating, weight loss, tremor, and anxiety. These symptoms can be treated with a medication which blocks thyroid hormone production or with radioactive iodine which destroys the cells which produce the hormone.
Goiter is best treated with surgical removal of the thyroid gland. The surgery can be quite tricky since the gland is very vascular, and heavy bleeding can occur. Also, the nerve to the larynx passes through the gland and can be damaged, causing a person to have lifelong hoarseness. The surgery is expensive, costing $500 at the hospital nearest to the Cross Clinic where it could be performed. There is a Catholic charity hospital about one hundred miles away where charges are much lower, but patients are often reluctant to travel that far. We continue to refer  our patients to this facility.

If you are able to donate, please send all tax deductible donations to:

First Presbyterian Church
800 West Texas St.
Midland, TX 79701
Please include: Dr. Bartha Uganda Fund in the memo

Written by Dr. Gregory Bartha

Sylvia was a young woman with a 3 year old daughter who reached out to me for assistance. She and the daughter were living in one room in a one floor apartment complex in a slum outside of Mbale. There was no door, only a cloth covering the entrance. Deep ditches with standing water surrounded the building.

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