The hospital – In 1959, Mgr. G.B. Cesana, a Comboni Catholic Missionary and Bishop of Gulu, founded St. Mary’s Hospital near Lacor, a village a few kilometres west of Gulu, the main town in Northern Uganda. In 1961 Piero Corti, a young Italian paediatrician, was assigned the direction of the hospital. This consisted of one outpatient department and few wards with about 30 beds and few Comboni Missionary sisters who were midwives and nurses, and some local staff trained on the job. The chaplain and the “builder brother” were also Comboni. Other wards were under construction. Piero was soon joined by a young Canadian surgeon, Lucille Teasdale. They had met in Montreal a couple of years earlier during their postgraduate studies and had shared their dream of being missionary doctors. Lucille accepted Piero’s offer to get the surgical ward at St. Mary’s up and running “for a couple of months”. Their marriage in December 1961 in the hospital’s chapel was the start of a lifelong commitment in developing Lacor Hospital “to offer the best possible care to the greatest number of people at the least cost”.
Uganda – In October 1962, Uganda (until then a British Protectorate) declared its independence. In 1966, Prime Minister Milton Obote suspended the constitution, declared himself President with far-reaching powers and remained in power until 1971, when he was deposed during a military coup.
Uganda – In 1971, the chief of the army Idi Amin Dada dissolved Parliament with a coup, took over absolute control and declared himself President for life. The country started on a spiral of severe economic depression and social disintegration, political repression, extremely serious violations of human rights with ethnic persecutions (particularly amongst Acoli and Lango peoples who supported Obote and made up a large part of the army). Between 100,000 and 300,000 people are estimated to have been killed during this dictatorship.
The hospital – The hospital’s Nurse Training School was inaugurated in 1973. Two Peripheral Health Centres were opened at Opit and Pabbo in 1974, followed by a third in Amuru two years later; at first they conducted only outpatient activities, but a ward was added a few years later for in-patients. The foundations for Primary Health Care were being laid, and at the same time Lacor Hospital started to train its first health educators. It was also becoming easier to rely on volunteer doctors thanks to the Italian Foreign Ministry’s Cooperazione Tecnica (the Italian Government Agency for Development Aid). In the meantime, it became increasingly difficult even to obtain the simplest of goods and construction materials, which had to be sent from Italy. For this reason a “support group” was established in Besana Brianza (near Milan), and was run on a voluntary basis by Piero’s family, particularly with the help of his nephew Mario Vismara, who still presides over it.
Uganda – Towards the end of 1978, in reply to an invasion across the border in Tanzanian, Nyerere mobilised the Tanzania People’s Defence Force, which was joined by various groups of Ugandan refugees united under the banner of the Uganda National Liberation Army (UNLA). The Tanzanian army invaded Uganda and rapidly took the capital Kampala in April 1979, but took several months to reach the North, where it was hailed as a liberation army. Once Amin had been deposed and his troops despatched, the Tanzanians withdrew.
The hospital – For three months, while the Tanzanian army slowly moved north, the hospital was cut off from the rest of the world. Lucille was the only surgeon in a vast area capable of doing complicated war surgery; most cases were Amin’s soldiers who had wounded one another. The hospital was located on the escape route used by Idi Amin’s army as it retreated, and was ransacked by the escaping soldiers in the days leading up to the arrival of the Tanzanians in Gulu. An officer of the Tanzanian army stated that St. Mary’s was the first hospital they had found open and operative since they had entered Southern Uganda several months earlier.
Uganda – Following a succession of presidents and military commissions, Obote returned to power and was elected to his second term thanks to rigged elections, in 1980. His security forces were to have one of the world’s worst human rights violation records. The country fell into harsh economic and social decline and plunged into chaos. Obote’s government forces, in the effort to counter the National Resistance Army (NRA) insurgency led by Yoweri Museveni, razed whole areas to the ground particularly around Luwero, north of Kampala along the road to Gulu. In 1985, General Bazilio Okello took over and established a military government.
In 1983, Lacor was approved for internship of doctors newly graduated from the Makerere faculty of Medicine. Doctors Lukwiya Matthew, Ezati Alidria Isaac and Orac Sam were amongst the first interns to come to Lacor. From 1984 Lacor had a training programme run directly by the Italian Development Cooperation. Almost all the staff at this point were Ugandan: Lucille and Piero’s dream was beginning to come true. But the first cases of “slim disease” were the initial warning signs of the future AIDS pandemic. Brother Elio Croce, a Comboni Missionary, arrived at Lacor to manage the technical department.
Uganda – In spite of a number of attempts to come to an agreement, the Okello government tried to repress the NRA uprising with extremely serious human rights violations. In January 1986, the NRA took the capital, and pronounced Museveni president. The new government drastically reduced the human rights abuses that had been the calling card of previous governments, liberalised politics and the press, and started a wide range of economic reforms. In the north of the country, however, out of a series of armed groups who arose against the government Joseph Kony’s United Holy Salvation Army (later LRA, or Lord’s Resistance Army) emerged and soon distinguished itself for ferociousness, bringing death and destruction to the Acoli population. From this moment until 2007, an estimated 60,000 people, mostly children, were abducted by the LRA. In 1988, President Museveni created the Ministry for Pacification of Northern Uganda, based in Gulu.
Projects with the Italian Ministry for Foreign Affairs continued to help with the training of Ugandan medical interns and the building of a second surgical department along with 3 more operating theatres and other units. Among the new medical interns were Dr. Opira Cyprian (now a specialist in radiology and Chief Executive Officer at Lacor) and later Dr. Odong Emintone (today a specialist in gynaecology and Medical Director at Lacor.
In these years the hospital was repeatedly ransacked night and day. Some nurses were kidnapped and released in exchange of drugs and money. For safety reasons, over 90% of the hospital staff lived with their families inside the hospital grounds, and at night many nurses and student nurses often slept under the bushes or in the buildings still under construction to avoid being kidnapped.
In 1985, Dr Lucille was diagnosed with AIDS she had probably contracted while operating on war casualties. However, she was advised to continue her work, given the extremely low risk that she could infect the patients, compared to the much greater risk to the untreated patients.
In 1986, the Cortis’ were awarded the Sasakawa World Health Prize by the World Health Organisation for the Primary Health Care programme they established at Lacor.
Uganda – March 1991 saw the start of “Operation North”, a large-scale attempt by the government to destroy the Lord’s Resistance Army: the entire north was isolated, the few humanitarian organisations present at the time were forced to leave the area. The operation managed to reduce the members of the LRA from thousands to a few hundred; the latter retaliated by increasing the brutality of their attacks on their own civilian population and anyone (whether real or suspected) who collaborated with the army. The population was hit hard by the LRA, with thefts, lootings, mutilations, kidnappings and torture. Human rights violations were also perpetrated by the army. This painful period saw the start of the terrible “night commuters” phenomenon, mainly involving women and children who would take refuge for the night in places that were considered safe, such as schools, hospitals (like Lacor) and churches, only to return home the following morning. This was to avoid being kidnapped by Kony’s LRA, who would force them to join its ranks.
The disruption continued to affect the hospital, and culminated with the kidnapping of Dr. Matthew, who was held by the guerrillas for a week. The tuberculosis ward was built, but the peripheral health centres of Amuru, Pabbo and Opit had to be evacuated, and were then looted and left only half standing. The new interns included Dr. Ogwang Martin (now specialist in general surgery Lacor’s Institutional Director). A new project by the Italian Development Cooperation was approved for the training and empowerment of Ugandan staff. At that time there were 5 permanent Ugandan doctors at Lacor. Dr. Matthew went to Liverpool for a Masters in Tropical Paediatrics where he was, as always, the best student. In spite of the offer made to remain there for a PhD, Matthew returned to Gulu, out of his sense of responsibility towards Lacor and his people.
In the wake of Matthew’s kidnapping, the Cortis prepared for the possibility of evacuation. At the prospect of the complete closure of Lacor, the guerrillas agreed to respect the hospital. The Cortis remained where they were. Because of this, Piero was awarded the Silver Medal for Civil Merit by decree of the President of the Italian Republic. Lucille was made a Member of the Order of Canada and received several other distinctions for her work with AIDS patients.
Piero and Lucille started working on the project to establish two foundations, one in Italy and one in Canada that could contribute to guarantee the funds, technical assistance and logistical support to the hospital.
Uganda – The violence further intensified when Kony, head of the LRA, obtained the help of the Sudanese government. In 1995, the LRA also attacked rebels in South Sudan and the conflict began to receive international press coverage. Attempts to hold peace talks were attempted by the international community between 1996 and 2001. Nonetheless the atrocities continued; kidnappings, sexual violence, abductions and forced enrolment of child soldiers and attacks on internally displaced camps with civilian victims were daily occurrences. Attacks on vehicles and the use of anti-tank and anti-personnel mines also intensified.
In 1996, Museveni won the presidential elections. In the south, life continued to improve and the economy gained ground.
Lacor Hospital was now a 450 bed-hospital with 400 Ugandan staff. It was chosen as the main site for the Italian Superior Health Institute’s project supporting the Uganda government’s plan to combat AIDS, of which Lacor was among the first sentinel sites. In 1995, the hospital’s new out-patient department was inaugurated. It was funded by the Italian Episcopal Conference, which from then on was to provide long-standing and vital support to the hospital.
Piero, who was convinced of the need to give Lacor a solid administrative structure, placed the hospital’s administration and relations with donors in the hands of Dr. Bruno Corrado. With a degree in law, a degree in medicine, a specialization in anaesthesia and ten years’ experience in health projects in Tanzania, Dr Corrado created an accounting system and started annual financial reports. The hospital’s board of directors was renewed and met regularly from then on. The peripheral centres of Opit, Pabbo and Amuru were reopened, but the completion of the works was to coincide with a large-scale resumption of rebel activities.
While it had not been invaded since 1989, in 1996 the hospital found itself in the middle of a war: 90% of the local population was living in internally displaced people’s camps where the child mortality rate was very high (with one quarter of all children failing to reach the age of five) owing chiefly to poverty-related illnesses: malaria, diarrhoea, malnutrition and pneumonia, due to the desperate conditions of destitution, crowding and lack of essential living conditions.
Two foundations, the Fondazione Piero e Lucille Corti (Milan, Italy) and the Teasdale-Corti Foundation (Montreal, Canada) were created in 1994. Piero was Chairman of both.
In 1996 Lucille’s condition deteriorated seriously: her weight was down to 35 kg and she kept herself going with i.v. fluids. Despite this, she continued to work 6 hours a day in the outpatient department until April, when Piero took her to Italy in an attempt to improve her state of health. In spite of everything, Lucille continued to worsen and died in Besana on August 1, 1996. Piero took her body back to Uganda so she could be buried in the hospital grounds.
In spite of the guerrilla warfare which had flared up around Lacor, the hospital continued to be fully operational, with an increase in the number of patients treated which reached 150,000 a year.
The Ebola viral haemorrhagic fever: Lacor Hospital makes the headlines on newspapers around the world.
In October 2000 Dr. Matthew was recalled urgently from Kampala (where he had just finished a Master in Public Health) because of the sudden death of three nursing school students. After studying the records he immediately formulated the hypothesis of an outbreak of viral haemorrhagic fever, possibly Ebola (one of the most infectious, rapidly spreading and lethal diseases known). He raised the alarm and organised the fight to contain its spread by setting up a large isolation ward for the patients and ambulance teams to bring suspect cases to the hospital and bury the dead. Experts arrived from around the world (the US government’s Centers for Disease Control and Prevention, the World Health Organisation from Geneva). The CDC’s “special pathogens unit” set up a field laboratory at Lacor: for the first time, an Ebola epidemic could be observed within a hospital environment; diagnosis could be confirmed with laboratory tests on site, patients were assisted clinically. The scientific results and knowledge acquired were considerable. Over 100 staff members agreed to work alongside Dr Matthew in the isolation ward or in the ambulance teams. Another isolation ward was set up in the Gulu Government Hospital.
This was the largest ever reported outbreak of Ebola Haemorrhagic Fever, with 425 cases and 224 deaths attributed.
Of the staff members who heroically agreed to risk their lives to help the people who had fallen sick with Ebola, 13 died: Ajok Christine, Ayella Daniel, Aol Monika, Ognebo Helen, Sister Pierina Asienzo, Ojok Simon Victor, Kiya Florence, Akullu Grace, Auma Mary Immaculate, Lanyero Christine, Odota Margaret and Aryemo Santina. On December 5, 2000, the last member of Lacor’s staff to lose his fight against Ebola was Dr. Matthew Lukwiya. He asked to be buried alongside Lucille.
When asked for his opinion on these deaths, an expert from the WHO answered that Lacor had one major risk factor: it was a “compassionate” hospital, meaning that staff did not abandon the sick in the isolation ward, but cared for them and tried to provide support therapies (there is no cure for Ebola) in spite of the extreme personal risk they ran.
Uganda – After having kept away for some time for fear of the Ebola outbreak, the rebels returned in force. After the events of September 11, 2001, the United States declared the LRA a terrorist group. Child kidnappings by the rebels intensified and the numbers of people entering Lacor in search of a safe place to sleep reached peaks of 10,000 a night.
The hospital had to face a serious post-Ebola crisis due to the fear and financial constrains. The hospital had to change the way it worked, such as using disposable materials only and expanding the laboratories. If a patient died it was essential to understand why; any unexplained death or a slight increase in the number of deaths meant immediately raising the alarm. An isolation ward was built so that any suspected cases could be quarantined. In the space of a few months the hospital resumed work in full, and the number of patients increased as never before.
Piero suffered greatly as a result of Matthew’s death and his health deteriorated as a consequence. After being diagnosed an inoperable pancreatic cancer, he died in Milan on Easter Sunday 2003. He was taken back to Uganda to be buried alongside Lucille (on her right, according to the Acoli tradition) and Matthew.
Uganda – In 2006, the rebels were driven out of Northern Uganda and took refuge in Sudan and then in Congo, where they are still massacring people. Although no formal agreement has been signed, in actual fact the war is over. There is now a feeling of security and people can travel freely, even at night. Most of the displaced (up to 90% of the district population) have returned to their homes or have settled in the larger towns.
The frontier with South Sudan is open, and Gulu has become an important centre for cross-frontier trade. The town population has almost tripled, new buildings have mushroomed, hotels and banks have been built and several companies from Kampala have opened up branches.
In 1993, following an agreement with the newly founded Gulu Government Faculty of Medicine, Lacor Hospital became a teaching site and the Lacor campus was built. In 2009, the year of the Hospital’s Golden Jubilee, the first students have graduated.
The population still lives in abject poverty, but with peace has come the hope that the north can finally enjoy the economic development which the rest of the country has been enjoying in recent years.
With its peripheral centres of Amuru, Pabbo and Opit, the hospital now has 550 beds and 600 employees. The number of patients treated in the outpatient departments and on the wards is continuing to rise, and in 2009-2010 has passed the 330,000 patients-a-year mark.
The hospital prepared its first strategic plan for the 2007-2012 period.
Three things that were very close to the Cortis’ heart have been realised, although they did not live long enough to see this.
The first was that AIDS patients at Lacor would also be able to receive the anti-retroviral drugs that came too late for Lucille, and which are now guaranteed to over 2,500 people.
The second was that the hospital might one day become a university teaching centre. In 2009, the year that has marked the Hospital’s fiftieth anniversary, the first medical students have graduated. All of them have passed through the classrooms and the wards of Lacor Hospital.
The third was that the hospital might one day be guided by Ugandan managers. On March 1, 2008, Dr Opira Cyprian was appointed as the new Executive Director of the hospital, working with the Institutional Director Dr. Ogwang Martin and the Medical Director, Dr. Odong Emintone. All of them came to Lacor many years ago, as newly graduated medical interns. Today, they bear the task of carrying the hospital forward, with the help of the two foundations.
The hospital began to grow thanks to Piero and Lucille. Piero had an aggreement with the Bishop: he would not ask the Diocese for funds but would search for help elsewhere. In exchage the Diocese allowed him to run and develop the hospital autonomously. Much of Piero and Lucille’s time when not working would henceforth be dedicated to finding the funds and materials needed for the hospital’s survival and development. The Padua-based CUAMM (now Doctors for Africa CUAMM) started sending volunteer doctors carrying out two years’ civil service; this collaboration would continue for over 20 years.