Tag Archives: maternal health

This Lopsided Earth

Ugandan baby

Scan after scan after just-to-be-safe scan

The Risk of just-born jeopardy,

Entirely absent from my pregnancy plan,

Concealed by the masters of modern medicine.

Launching oft-futile guerrilla assaults;

Striking in response to the misstep of man

Rebellion against the promised assurances

of midwives and monitors and surgeries and scans;

But rarely a success in battle.  If it occurs:

there is shock, and shame, and blame, and a cry

That ‘no child should die’!

No baby should lie

Without a life to satisfy

 

But in the occupied territory, where risk reigns in little lives:

Over the great chasm of access and supply

Faintly, if you have ears eager to listen to the cry

And block out the lapping of luxury at your heels

And make room for what this dystopia reveals

And pierce through the privilege that cocoons your truths…

 

With each live birth, each safe passage to our world;

Comes the quiet grief of a mother’s tears

Sidelined by other-ness and foreign fears

Whispering of sweet promises unkept

Until, with un-lived memories; she wept

Wept for the babe, their newness now gone

Wept for a health system she cannot depend on

Wept for the vacuum of drugs, staff and cars

Wept for tiny hands, now safe in the stars.

 

Geography seals fates for these babes, and thus;

They’re torn from women who, despite the distance, are like us…

But with sad acceptance of their world;

Where children do die

Where babies do lie

Without a life, to satisfy…

In a world where risk is always nigh

 

No just-to-be-safe scans, no monitors, no available staff

The certainty of risk beyond our comfortable grasp

A gamble for mothers, who bet on their own hearts;

A gamble unseen, unheard by us; their counterparts

A gamble, in Uganda, which mothers’ lose,

If only there were other choices to choose….

On this lop-sidedly serviced earth,

For every 19 Ugandan babes?  1 ill-fated birth*

 

A little story behind the poem:

I started writing this poem a few years ago, when a staff member at MH lost his newborn baby. It was him and his wife’s first baby, and the grief seemed to swallow up our team for a few days. I remember the jarring nature of the baby’s death, some 12 hours after birth, when staff were still celebrating the original message that he and his wife had welcomed new life into the world.

It was tragic, and mainly left unexplained. There was deep sadness. One of the things I love and find frustrating about Ugandan culture – in equal measure – is the passive acceptance of, and embracing of the world as it is with all its suffering. It seems to allow Ugandans the ability to grieve well, and then rise up out of the ashes, resilient as ever. In the same breath, this acceptance often prevents a critique of the source of the suffering; so often relinquishing the possibility for questioning and change.

This particular little baby died in a big hospital; all seemed fine until it wasn’t. MH doesn’t offer maternity – we don’t have space or resources to do so – though we hope to in the future. But the lack of quality maternity services in our region, juxtaposed against the incredible obstetric/neonatal care available in Australia that I have been lucky enough to access with my own births, will always stay with me, and drives much of our passion in the journey of MH.

*based on 2017 infant mortality rate of 54.6/1000 live births

False quotes and failing health…

In light of all that has happened over the past few months, including the closure of the Maranatha Health clinic due to a factory being illegally put up next to our land, I have been following the Ugandan media with interest this week. Mostly, to track the articles that are being written about Maranatha. (By the way, I wrote this blog over 6 weeks ago but have only got around to posting it now!)

When I first moved to Uganda, I took an overly-keen interest in the newspapers, delving very deeply into the politics of this country.  Like many Ugandans, I became quite wrapped up in the politics of Uganda, the key players, the scandals, the economy, the issues. The average educated Ugandan’s interest in politics is a fascinating phenomenon that I’m still getting used to. After 25 years of my life lived in Australia, where most  young people who have finished high school can barely offer up the names of the PM and deputy, it is still bizarre to me that so many Ugandans know all the key ministers, their families, their business dealings, and scandals. In essence they are the Ugandan version of celebrities.

However, about 1 year in, and after reading about the millionth corruption investigation story, my interest in the media waned, especially since 99.9% of the time nothing was achieved by reporting the story. It made me a little too cynical, reading again and again of men being found ‘not guilty’ for crimes that have appeared to cost the country millions of dollars in tax payer funds. Although I would’ve loved to, I also didn’t feel (and still don’t) that I should share my thoughts publically about such issues considering the sensitive nature of my employment and status in this country. Furthermore, although the media is open, free and can report essentially whatever they want, I feel almost every story is fanatically event-based, rather than drawing Ugandans into a bigger-picture conversation on long term solutions to the issues facing the country.

Last week reminded me again of why I have tried to avoid getting too heavily invested in Ugandan politics and media. Keeping track of the headlines, two things have been highlighted to me:

Much journalism in this country (in my opinion) is amateur and opportunistic*. I was completely ignorant until a few weeks ago that when one needs to have a story written in this country (unless it is a national issue) one must PAY journalists to write it. Yep, you heard me correct. Over and above the wages that journalists receive from the newspaper, to have an investigation and story written about the issue in Kamwenge (or any issue for that matter, so I’ve been informed from Ugandan friends), we were expected to fork out money (per media outlet/journalist) for the mere privilege of their interest. Now let me get this straight. We do not pay them for a one sided account. After you fork out such ridiculous sums of money for mediocre reporting, they write what is purported to be a ‘balanced story’ (while others take your money and write nothing!). So far however, the quality of articles has been at best slightly inaccurate, at worst totally missing the point of the issue. Every single article written so far has described us as being from Austria (it really isn’t that hard to get the donor country correct, these journalists are degree holders for goodness sakes!); has dramatically misquoted or just plain made up ‘quotes’ we are purported to have said; and the one published the other day quoted a man in Kamwenge town – a maize dealer who is OF COURSE going to benefit and side with the factory – claiming that the residents don’t need or want the health centre, and can easily go to Fort Portal (70kms away) for treatment. Might a journalist point out or question the agenda behind his one sided view? Not in Uganda it seems! Moreover, most neglect to highlight or only vaguely mention, (1) the level of corruption and negligence of district officials which surely must have been present to put up a factory next to a health centre, and (2) the extremely poor quality of health services currently being offered in Kamwenge, that has been redeemed dramatically by the services at Maranatha, and do not currently exist elsewhere in the district.

The second thing that was sadly highlighted to me this week as I poured through the newspapers is, in a demonstration of ironic timing, a collection of articles lamenting the state of health and health services in this country. Of particular interest in the past week, I have read that new figures have shown the HIV rate is rising from 7.5 To 7.9% (the figure I suspect is much higher in Kamwenge); Family Planning levels in rural areas are decreasing; that child malnutrition rates are on the rise and now stand nationally at 35% (in Kamwenge they sit at around 60%); and maternal mortality is again on the rise, with the national figure now at 438/100,000 live births. Michael and I observe the practical realities of these stats everyday and they simply confirm what we are seeing in our own district. However, most alarming is the last statistic about maternal mortality rising. See, from my Masters, I have learnt a bit about health systems – their elements, different ways to strengthen them, schools of thought around this and also how to measure their capacity and effectiveness. One of the key ways to assess the efficiency and effectiveness of a health system is through maternal mortality statistics. Why?  Because maternal services rely on so many different aspects of the health system – things like the presence of primary health care services (ANC and delivery), staffing levels, transport mechanisms, referrals, emergency response, availability of drugs and equipment, and availability of tertiary/specialist care. All these services combine to ensure women do not die in pregnancy or labour (and so poetically, in countries like Australia, that maternal mortality barely exists). Basically what I am saying is that health services in Uganda, generally, are decreasing in quality, in turn producing these unfortunate statistical realities.

Which begs the question – why allow a health centre doing such a fantastic job fighting against these statistics, to be forced to shut by putting a factory next door? Why aren’t the district leadership – among others – viewing this as an issue of urgent and significant importance?

And, why oh why, didn’t the journalists of Uganda identify – and point out the link – between the broader problems of health in Uganda they were writing about this week, and the articles written about Maranatha Health, a much needed service subsidizing a broken health system.

Thus endeth my rant.

*As a disclaimer, I’m sure there are many fantastic journalists in Uganda – I may have lucked out! Also, there are many things that combine to make this a problem – including lack of support and good educational opportunities, corruption, and small salaries.

She arrived in a beat up Corolla

The other day a woman from the village was brought to our clinic.

Unconscious

Her body in shock

In the back seat of a beat up Corolla

She came with a few relatives and an educated man from Kamwenge town who was from the same minority tribe, found the woman, and rushed her to us.

The woman had given birth recently, at home, with only a relative to help her. She had come to us for antenatal a few weeks earlier, but had made the decision to stay at home for the birth. She and the baby had not been for a postnatal check-up. When the relatives saw the woman was unwell they delayed taking her to the clinic for days. It might be expensive, after all.

So there she was, her limp form lying in the car.

Then there was a lot of quick, fast discussion in Rukiga and English – between the well dressed educated man, the relatives from the village, our staff, Michael and myself. What should we do?

Could we admit her and try and help?

Do we have anything we need to treat this woman in such severe condition?

Could we find an ambulance to transport her to Fort Portal?

Would she die along the road if we tried to send her somewhere else?

Why hadn’t we already purchase our Oxygen concentrator that we desperately needed?

Did any of the other health facilities in Kamwenge have blood ready for a transfusion?

No.

Less than a week later, we now have an oxygen concentrator. We are almost set up for blood transfusion.

But the woman is already dead, so what use is that to her now, I ask?

Bring your blade, bedding and basin…

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?”