A good friend of mine who lives in Kamwenge town is pregnant with her second baby. During the birth of her first child, her labour became obstructed. Because there was no place in Kamwenge that could help her, she travelled 1.5 hours on a dirt road, in severe trauma, on public transport to reach the nearest clinic that could operate on her. Her and her beautiful boy survived, although she now has a great fear of childbirth. Every time I see her, she fervently asks for me to pray for the safe arrival of her baby due in August.
But she was fortunate enough to be able to afford the cost of transport to Fort Portal, and was able to get there in time.
In Kamwenge, where the population has reached at least 350,000, there is no district hospital. The two main clinics in the district do not offer Emergency Obstetric Care. There is no working theatre. No running water or electricity. Many of the health staff are hardworking, compassionate individuals who are tired of having so few drugs and equipment.
Being a woman in Africa is tough. And one of the toughest things of all is giving birth. I read lately, in a journal article written by an anthropologist (I can’t remember the name of the article!), that in an area of eastern Uganda, childbirth is sometimes referred to in vanacular as ‘the trap’ because of the risks involved.
The maternal mortality rate in Uganda is 506/100,000 live births. In Kamwenge it is unknown, but expected to be much higher. Every year, 1.5 million African children are left without a mother because she dies trying to give birth to a brother or sister. The risks in child birth are a struggle faced almost exclusively by poor women, with 99% of maternal mortality in developing countries. It is astounding in this era of medical advancement, that so many women continue losing their lives giving birth, and it is for this reason that Maranatha Health have chosen to focus on improving maternal mortality in Kamwenge.
Despite what I know, every now and then I wonder if what we are doing is worth it – maybe the situation in Uganda’s health care system isn’t ALL that bad.
Then, I read an opinion piece by Frederick Golooba-Mutebi in this weeks East African:
Maternal deaths: Why Ugandans are victims of their own civic incompetence
Recent media reports detailing the tragic deaths of expectant women and their unborn or newly-born babies in referral hospitals and health centres across the country have laid bare the crisis in Uganda’s healthcare system and made a laughing stock of the NRM government and its extravagant but empty claims about being focused on service delivery.
The anger, despair and disgust the many preventable deaths have caused are captured in the decision, reported in this column last week, by activists to take the matter into their hands and drag the Museveni government to court.
Reports from the “grassroots” indicate that in some cases relatives of the victims take matters into their own hands and threaten health personnel with violence. Others, however, behave as if their experience were the natural order of things and simply return home to bury their dead.
Before the decision of activists to enlist the law, only in a few isolated cases had victims of Uganda’s shambolic maternal health services sought to enlist the help of the police or courts of law. Two cases stand out.
One involved the death in early May of one Joyce Nabatanzi at Nakaseke Hospital, allegedly because nurses had been negligent. I have no idea how or where the story ended. However, a senior officer who claimed his staff were hardworking attributed the incident to the hospital having run out of essential drugs and supplies without which lifesaving surgery could not take place. Several phone calls to the National Medical Stores had not led to the desired response. To make matters worse, the hospital did not have an ambulance to transfer the patient.
The other was of a couple who lost a baby at Jinja hospital, also because of alleged negligence by nurses. The bereaved woman spoke for herself: “These people should improve. I heard countless insults from the nurses using obscene language. They handled me like I was a thief, pulling me from all sides.”
Unwilling to accept what had happened, her husband filed a case with the police. Here, as in Nakaseke, the hospital lacked drugs and supplies, as the father pointed out: “I bought everything since the hospital did not have the needed items to facilitate delivery.”
To add insult to injury, he could not get a post-mortem without coughing up more money: “Now someone tells me if I want a post-mortem, I have to give the pathologist transport.” According to a police officer on the scene, this was not the first time incidents of this kind were happening at the hospital.”
With all this in mind, it is difficult not to equate going to give birth at a public health facility in Uganda to going to war. As with combatants in war, here too, there is no way to tell whether one will come out alive.
There is, however, a sense in which combatants going off to war are better-off: They do not buy their own uniforms, guns, bullets, bombs, boots, or even food.
Meanwhile, expectant mothers going into government facilities must carry their own food, gloves, razor blades, sugar, tealeaves, bedding, basins and even saucepans. You have to see it to believe it. You would be forgiven for thinking they are moving house.
It is all too easy to buy into stories of the by now legendary negligence of health workers in Uganda. That is until you learn a thing or two about the conditions many face at work. Consider these statistics, which appeared in a recent newspaper report: Hoima hospital has 97 staff out of the 197 required. It requires 56 nurses but has only 34. It is run by eight doctors out of the required 35.
A brave nurse summed up how things work over there: “There is no other option than doing what we can and leaving what we can’t. What do we do when things are beyond our reach?”