Mapping the way to Uganda’s Major Limb Loss (MLL) victims

Ravaged by two decades of insurgency, Northern Uganda’s Acholi sub-region is home to countless victims of Major Limb Loss (MLL) caused by landmines, gunshot wounds and brutal punishment amputations.

Twelve years on from the 20-year insurgency, and many of those mutilated remain suffering alone in Acholi’s remote towns and villages, which are lacking in even the most basic health and rehabilitation services, and are plagued by poverty, malnutrition and disease.

Dr Jonny Huck, Lecturer in Geographical Information Science, The University of Manchester

Dr Jonny Huck

Lecturer in Geographical Information Science

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There is no official figure to determine how many MLL sufferers there really are in Acholi – although there are estimated to be many thousands. The tragic fact remains that these victims of conflict are the by-product of the brutal insurgency that waged from 1986 to 2006.

These individuals are victims of both war and geography.

Acholi is approximately twice the size of Northern Ireland, yet its population is much smaller. The region is sparsely populated, badly connected and, most significantly, poorly mapped.

For researchers, aid agencies and other humanitarian organisations, this has made understanding the true extent of MLL sufferers in Acholi, and the level of requirement for health and rehabilitation provision, an almost impossible task.

Dr Jonny Huck, Lecturer in Geographical Information Science (GIS) at The University of Manchester, is aiming to address this.

Measure of magnitude

Inspired by similar work conducted by Sri Lanka’s Metha Foundation, which provides prosthetic limbs to victims of the 26-year conflict between the Sri Lankan government and the Liberation Tigers of Tamil Eelam, Dr Huck is using the power of geography to conduct Acholi’s first-ever prevalence analysis of post-conflict MLL.

In order to effectively determine the magnitude of MLL in the region, and in turn provide the most appropriate medical solutions, extensive mapping of Acholi’s population is required.

This is where the award-winning #Huckathon comes into play.

The #Huckathon mapping exercise (or ‘mapathon’) sees volunteers – many of whom are students of Dr Huck or from The University of Manchester’s wider Geography community – collaborate to create paper and digital maps of Acholi.

A high-profile #Huckathon outing was at the three-day 2018 Bluedot Festival, held at the University’s Jodrell Bank Observatory, and undertaken by more than 700 members of the public, while the information-gathering initiative has also been adopted by local schools, the Manchester Science Park, the Manchester University Geographical Society (MUGS), and the University’s Humanitarian and Conflict Response Institute (HCRI).

Participants use techniques including GIS, on-the-ground surveying, and machine learning approaches using high-resolution satellite imagery, which detects the huts in which many of the population reside, gradually adding huts and roads to Dr Huck’s digital map, which is hosted on the dedicated #Huckathon website.

Huts in Uganda.

Complementing the efforts of #Huckathon participants helping to map huts and roads online, Dr Huck uses on-the-ground surveying and machine learning to pull all of the information together to create a map. This data then directs Dr Huck’s on-the-ground activities and further improves the cutting-edge machine learning algorithms.

“Being able to help the Acholi people to recover from such a terrible conflict, and perhaps in other respects, is tremendously rewarding.”

“If we can map 5% of the country in mapathons, the next 90% will be mapped automatically, leaving the last 5% for the mapathons,” Dr Huck explains.

“The map can always be of better quality, more detailed and so on, and so it will never be ‘finished’, but the goal is that the mapping effort can one day be a self-sustaining one in Uganda and that the software we developed to achieve that, from data collection right through to on-demand printing, can easily be transferred to other parts of the world.”

The resulting maps, which are akin to the UK’s Ordnance Survey maps, will be freely provided to researchers, aid agencies and the people of Uganda to use as desired. They will also allow the prevalence analysis to be conducted much more efficiently and accurately.

Most importantly, developing a greater understanding of Acholi’s population distribution has already led to some outstanding, life-changing outcomes.

Working alongside University of Manchester colleagues Mahesh Nirmalan, Professor of Medical Education, Tony Redmond OBE, Professor of International Emergency Medicine, and Caitlin Robinson, Lecturer in Geographical Information Science, as well as Ruth Daniel, Co-Director of In Place of War, and partners from the University of Gulu, Uganda, Dr Huck and his team have installed a permanent orthopaedic workshop in the town of Gulu. Their maps were used to provide data connections to all schools and hospitals in the region, and facilitate a cervical screening programme in South Uganda; Dr Huck expects the maps to be used in future town planning and resource planning.

The team has also constructed a mobile orthopaedic clinic that can travel between even the most remote villages to provide MLL victims with prosthetic limbs and ongoing care. Villages that previously lay unchartered are now literally on the map and, crucially, the victims that suffered alone can now receive treatment. 

Making a real difference

The tragedy of post-conflict MLL in Acholi has been exacerbated by unavoidable geography, but now it is geography that is providing significant solutions.

“Being able to help the Acholi people to recover from such a terrible conflict, and perhaps in other respects, is tremendously rewarding,” says Dr Huck, whose work scooped a University of Manchester Making a Difference Award for an ‘Outstanding contribution to social innovation’ in 2018.

“It is a wonderful example of how geography can make a substantial difference to people’s lives.”

Initial funding from the Arts and Humanities Research Council (AHRC) and Medical Research Council’s (MRC) Global Public Health scheme has allowed 50 people to receive a new, specially-constructed limb and associated care, enabling these MLL victims to work and participate in their community more fully.

Funds are now being sought to fit limbs to thousands more victims, identified through Dr Huck’s ongoing prevalence study, and to address numerous other endemic post-conflict health issues that the team have encountered in the region – such as unhealed and infected wounds, severe disfigurement, and a wide range of mental health issues.

The development of this funding model will be informed by the ongoing disability prevalence analysis, which will use research techniques such as interviews and questionnaires.

“The University of Manchester enabled us to assemble a network of researchers who are leaders in their field and with a wealth of experience,” concludes Dr Huck.

“Without this, we would not have been able to secure the funding for this work, nor would we be able to undertake it.”

Read more about the #Huckathon at the Bluedot Festival.