Tag Archives: frustrations

The enthralling exhilaration of the unknown…

Maranatha Health in Kamwenge has received a gob-smacking, hideously ridiculous, completely unexpected setback, and by way of association, so have I. Before I share my thoughts about it all, here is a link to a letter we sent to our supporters recently posted on FB on the MH page, to give you some context and information into the issue that has arisen. If you haven’t read this, the rest of the blog probably won’t make much sense. In summary, a maize mill factory has been constructed next to our health centre, and now chugs out noise and dust 24/7, forcing us to close the health centre and move off-site.

So, less than ideal, obviously. Frustrating. Unjust. Corrupt. I could think of some less-creative, four letter words as well, but will spare my readership the full brunt of my frustration.

To be honest, I don’t really feel like writing today. In fact, today I feel like crawling up into the foetal position, eating copious amounts of chocolate, lamenting the world and my place within it, and reading some of the more sinister of Shakespeare’s sonnets.

But alas, I write. Partly for therapy, partly to let everyone know that my world continues to spin, and partly to share this journey with all of you because the fate of Maranatha affects so many inside and outside of Kamwenge.

Once again, for the millionth time since being involved in this Organisation, I find myself uncomfortably squeezed into the enthralling exhilaration of the unknown.

Once again, I am reminded that I am a teeny-tiny person in this very big, very wide world and my comforting illusion of control has again been mocked and exposed by that same afore mentioned world.

Despite the dramatic dialogue in this blog, we are feeling quite positive, generally. Things are really looking up. We have had some extremely positive developments in the past few days. In addition, media is now splashing the story (albeit slightly inaccurate, tabloid-esque versions) around Ugandan newspapers and TV news.

I’m just having a bad day.

The first few weeks, when we discovered that yes, it was definitely a factory next door, and yes, they were running their machines 24/7 – things were tough. At that point we knew very little about Ugandan law, about industrial and residential zones, about environmental acts, and so had very little understanding of how we could challenge such a situation. We lacked voice and a platform. At least now we know what we are dealing with and the channels for redress. Of course, on a day-to-day level, that knowledge doesn’t make it much easier to manage the constantly oscillating situation and our parallel emotional response; one day we feel we are close to winning the battle and will be reopening the clinic in no time, and the next day we wander around our home listlessly wondering if we should start packing our bags for Australia.

Michael and I have prayed in the last month more than I think either of us has ever prayed before. Not that it’s a very noble prayer these days – most of my prayers consist of a repeated request to finish my season of ‘character building’ and a demand for life to get easier, speckled with a less selfish appeal for justice for the poor of Kamwenge.  But I have never before been so aware of how frustrating it must be, for God to continue calling people to love, when the world is so interested in other sinister motivations and agendas.

Every time we think we are moving closer to a solution, we face serious set-backs and suffocating scenarios, reminding us again of the complexity of Ugandan concepts of justice. In a conversation with our Ugandan father, we discussed concepts of justice in Africa, and how the law is applied. Justice here is tangled and twisted with power and relationships, with desires for peace and amicability, with political and business motivations confusing responsibilities. Often it feels as if justice is a negotiation process between parties towards a resolution, rather than a direct application of law. The problem with this, of course, is that unless someone wise and fair is mediating this negotiation, those with more bargaining power and a louder voice will always win. The poor, thus, will always lose*.

Since this issue has arisen, we have found so few people outside Maranatha in a place of authority – a leader, an MP, a government technical worker – who immediately recognises or assumes the position of the law. Time and time again, we are required to remind those involved in resolving this issue exactly what Ugandan law states about residential vs industrial zones, about factories and Environmental Impact Assessments, and the simple ethical and legal realities of our case. More likely, they are interested in what the district leadership ‘thinks’ about the issue, the identity of the investor behind the factory, the size of the two investments for comparison, and what the political ramifications are.

Instead of the acknowledgement that I crave – that we did all the right things, that this project is necessary for the community, and through no fault of our own we are experiencing a grand injustice – many leaders patronisingly explain that this situation is ‘complex’ and ‘politically sensitive’.

It doesn’t FEEL politically sensitive to construct/approve a massive maize mill factory that pumps out dust and noise 24/7 next to the only decent health-centre-soon-to-be-hospital in Kamwenge district. To me, it just FEELS really, really, really stupid. Politically. Ethically. Environmentally. Legally. Everything-ly.

Of course, we have come across many compassionate Ugandans over the past 2 months who hear the story and immediately get behind our plight – who have offered so much of their own knowledge, networks and resources to help us fight this. Our Ugandan family have been a core support to us (we joke that we are currently Kamwenge refugees seeking asylum from the noise, residing in their home in Kampala), and our father, as the chairperson of our board, has wisely led us through the decisions we have had to make.

A few weeks ago I was sitting with some of our staff, after we called a meeting with all of them to discuss the issue. Annet, our receptionist and a compassionate woman who has grown up in Kamwenge, was sharing with me that she was called to help a relative in town. The relative’s child had severe malaria, and needed a blood transfusion. Since we have been closed to patients, the only way to get such a transfusion is to travel 1.5 hours in a vehicle to the next district. The 2 ambulances, owned privately by the churches, both charge fees of $40+ to transport people out of Kamwenge. The average wage per month in Kamwenge would be below this figure. Annet shared how she had to find the money immediately, to save the child. But she clicked her tongue and sadly asked “what do others do, those who can’t manage to pay?” then shook her head and quietly ushered to no one in particular “they take the child home to die”.

We have experienced some really tough stuff in Uganda to date. Some big challenges. But this one is a doozy. This one feels like one of those life-defining-moments, where until you see it resolved, there aren’t many answers to life’s questions, and the future looks like a blank canvas.

I honestly wish I could write a blog that stated that I know 100% that Maranatha Health will still be in Kamwenge in 1 year. I wish I could write that the district will fight long and hard to keep us here, since they know we are essential for this community.  I wish I could write that despite the corruption in Uganda, I still believe in the Ugandan legal system enough to say that we would win such a black and white case. I wish I could write that I am sure God will magically and miraculously end this problem.

I try to convince myself of those things every day.

But I don’t know.

All I CAN write is that we will give 100% to fighting for the poor of Kamwenge and their right to access quality health services– until we have won or lost.

And that God WILL be cheering us on, just like he has cheered on those who have challenged injustice throughout history, calling on those in this country that know him well, to act justly and righteously.

*On re-reading my description of justice in Africa, it occurred to me that this concept is more of a description of justice everywhere, at least at an international and corporate level.

Patients or Profits?

Perhaps it has something to do with the lack of, and ineffectiveness of, regulatory bodies. Perhaps the training at many Universities is below par. Perhaps it is due to the everyday Ugandan’s powerlessness and incapability of demanding and knowing their rights. Or perhaps it is the simple truth that money-motivated-medicine around the world always seems to behave badly.  I’m not sure why it is the way it is – I will not presume to give an opinion on a complex issue I know almost nothing about.

What am I talking about?

Poor quality medical services – in this case the private system – in Uganda.*

The public system in many developing countries has a lot to be desired, and a thousand reasons why this is so. But the private system? The system with money and drugs and equipment and trained staff on good salaries?

I wanted to share a simple story of something that happened the other day that left me bewildered. Before I share my experience, let me first say that there are many intelligent, professional, trustworthy doctors in Uganda who practice very good medicine. Unfortunately, they are not by any stretch of the imagination the majority.

Michael and I stayed with our family in Kampala for a few days last week. One night, our brother Pete (who’s a year older than me) staggered through the door complaining of a severe headache that he’d had most of the day. It had come on suddenly. After a heap of questions, Michael was convinced it was a migraine and all the symptoms pointed to this – whatever the case, we decided to take him to the Gensi’s family doctor, a private middle-class clinic a block from our place where he could get some fluids and painkillers. We (Michael, me, and Margaret, our mum) loaded Pete into our car to take him. It was peak hour, and so we sat impatiently waiting in traffic even though the clinic was literally around the corner, as Pete moaned and threatened to vomit in the car. Eventually, Margaret had had enough. She instructed Michael to put on his hazard lights, ordered him to drive on the wrong side of the road, abruptly jumped out of the car and starting stubbornly walking into the oncoming traffic (have I mentioned before that you don’t mess with Bakiga women?) as Michael eased his way past the jam on the wrong side of the road ignoring the glares from passing vehicles. Her display of motherly love was quite astounding, but I didn’t know whether to laugh at the situation or hide from angry faces in the vehicles that Margaret had forced to the side of the road.

Arriving at the clinic, a small building with a consulting room, a lab and a few rooms with beds, we found the doctor reading his newspaper. After getting his attention, he took a very short history from Pete – like 2 questions. Pete was convinced it was a migraine and not malaria; after all he had had malaria dozens of times in his life and knew what it felt like. Clearly though the doctor felt he had gathered the info he needed and had had enough of interacting with his patient, because at that point he wrote some things on a piece of paper, ordered a blood test, and told us to wait. There was no explanation given. Pete, in the meantime, was struggling to stay on his chair due to the pain.

After a few requests from Michael, they led him to a room with a bed in it, and shortly after a nurse came in. They apparently had the results of the blood tests back, although no staff mentioned this. She came loaded with several injections and ordered Pete to remain still as she jabbed him several times. He had no idea what the diagnosis was. No conversation with the doctor. No idea what treatment he was getting. No permission was sought to administer the drugs.

Pete was still dehydrated so Michael requested they get a drip into him. Reluctantly, they agreed. The headache had lasted a long time, so Michael also checked for signs of bleeding on the brain. Something they had also not bothered to do.

In the meantime, we were all curious to know what was happening, and what the diagnosis was. (These patients and their demands, how annoying…) Margaret went to find the doctor, who informed her that Pete had a bacterial infection. No further explanation.

Eventually, we found out what they treated him with. The list is as follows:

  • 1 shot of malaria treatment
  • 1 shot of anti-nausea
  • 2 shots of extremely heavy duty antibiotics
  • 1 shot of an anti-inflammatory (this one was actually for the migraine and very helpful)
  • 1 drip of glucose (used in patients with malaria), not helpful for rehydration

By this stage Michael was a little confused. He was convinced that all Pete had was a migraine, and he needed fluids and rest. So he asked the nurse to show him the lab results.

It turned out that Pete tested negative for malaria and negative for any bacterial infection. His white blood cell count was within the normal range.

After several hours, when he had slept and was feeling better, they discharged him and he came home. However, not without being told he would need to come back for the next three days, to have more anti-malarial and antibiotic injections. Up to this point, they had not mentioned money, but Pete was dreading the cost. From past experience, Pete estimated it would be around 300,000UGX  (A$150) or possibly more. That is big money in Uganda.

Now, I’m not a doctor. I have not been through medical school. But being married to a GP – wait – even visiting a GP on many occasions in Australia would have made me more equipped to deal with this situation than the doctor who saw Pete. Here’s ‘Kim’s General Practice Medicine 1-0-1’.

Lesson 1: Talk to your patient, gather a comprehensive history, think of all possible causes (not just malaria because it’s an easy diagnosis).

Lesson 2: Once you have a diagnosis, communicate this to your patient.

Lesson 3: Make sure your diagnosis is based on facts/lab tests/at least some semblance of science and NOT based on the fact that you can charge more money for medication if its malaria or infection (or both?!), which it clearly was not. If in doubt, run the tests again.

Lesson 4: If you are going to administer drugs, explain the diagnosis and medications to the patient and SEEK his permission to administer them. Again, communication is key! In Australia we call administering drugs without permission ‘assault.’

Lesson 5: Do not treat your patient for diseases he doesn’t have, so that you continue the spiral of malarial and antibiotic resistance that are out of control in places like Uganda where drugs are not regulated well.

Lesson 6: Don’t be a money-hungry incompetent idiot.

Thus endeth my rant for today.

*By the way, I don’t deliberately mean to exclude some of the terrible displays of medicine practiced in Australia – by a wide range of doctors.  Statistics show that the average private surgeon in Australia will operate many more times than necessary if there is a bit of money to be made and some fun to be had – often to the detriment of the patient.