My wife and I spent the whole of January 2012 in Kigezi, falling in love all over again with my homeland and her adopted home in Uganda. Most of our stay was very pleasant, the hospitality a sweet reminder of what we missed most about our country.

However, three heartrending images are indelibly seared onto our minds. Two involved two little children, whose stories we shall tell later, and one was of a man whom we found hovering between life and death.

On Saturday January 14, 2012, I strolled down the old boulevards on Makanga Hill, taking pictures of my childhood haunts. As I approached Kabale Regional Referral Hospital, I met Rugwiza wa Semiriho, my childhood friend, who introduced me to four young businessmen – three boda boda operators and one cab driver – who enriched me with their common sense and knowledge of the realities of Kigezi.

As I stood transfixed by their narratives about the challenges of healthcare in Kabale, a young woman approached us and requested Byaruhanga, the cab driver, to help her take her husband to their home in Kaharo so that he could die there.

“It is cheaper to transport him alive than when he is dead,” the woman stated with a matter-of-fact tone that was only betrayed by her sullen facial expression.

A bus had hit her husband the night before, which had left him with a potentially fatal fracture of his skull and other major injuries. A doctor at Kabale Hospital had attempted to operate on him but had abandoned the procedure upon realizing that it was beyond his competence. The man, semiconscious and still bleeding from his wounds, was receiving a blood transfusion. Should he survive until Monday, he would probably be transferred to Mbarara University Hospital, 140 kilometers to the east. She had no money and was not about to undertake the long journey to a strange place with a man who was as good as dead.

I entreated the woman to let me visit her husband to see what, if anything, could be done. With evident hesitation, the woman led me to her husband’s bedside in the Surgical Ward, a thirty-something bed unit that had a patient census more than twice the official maximum.

There was a vigil by the man’s bedside. Death was in the air. The solitary nurse looked resigned, many of her charges too sick to give her hope of saving their lives. Those who needed treatment in places where more advanced surgery was available were handicapped by poverty, among them CB, the woman’s husband. A trip to Mbarara University Hospital would cost the woman in fuel fees and allowances for the health personnel who would accompany him. The woman had taken the only logical option available to her. CB would have to die at home.

Ambulance-2
Kabale Ambulance interior: unaffordable fees

However, after some discussions, the hospital leaders agreed to transport the man to Mbarara immediately, at no cost to the woman. Someone offered the woman a modest donation of cash for her upkeep and transportation and we wished the couple God’s speed.

CB underwent neurosurgical treatment within 12 hours, news that was relayed to us by his wife via cellphone. Less than a week later, CB was reported to be walking around Mbarara Hospital.

On the morning of Thursday January 26, 2012 my cell phone rang. On the line was CB himself, reporting that he had just been discharged, with a clean bill of health, now on his way home to Kaharo, to live, not to die.

My wife and I had our bags packed and ready, for we were leaving for Mbarara. We would not see CB and his wife and would content ourselves with the deep satisfaction that our prayers had been answered. Perhaps we would live long enough to visit him in his home one day.

Our joy over CB’s recovery was tempered with the knowledge that he had just been a lucky man. His story could have been different, as we knew had happened to hundreds of others around the country who could not access the basic treatment that saved CB’s life.

Fully equipped and fully staffed Emergency Department a necessity at every hospital
Fully equipped and fully staffed Emergency Department a necessity at every hospital

Furthermore, should we need emergency life-saving surgery ourselves, Kabale Hospital might not do it for us, not because they would not want to but because they lacked the human and material resources that should be at a Regional Referral Hospital.

I am aware that people like CB do not appear on the moral and mental radars of the ruling classes of the land. Their premature deaths are mere collateral damage in a war on the Animal Farm of greed and economic exploitation that Uganda has become.

However, one question I have asked before warrants repeating. What if a catastrophic disaster struck any of Uganda’s district or regional centers, with the top rulers of the land among the casualties?

The logical response would be that they would be evacuated to the safety of Nairobi or South Africa. Perhaps the state of the art mobile presidential hospitals would be put to use, even as the Gulfstream jet’s engines revved at Entebbe, awaiting the injured rulers to arrive by helicopter.

The realistic answer is that there are injuries that require immediate medical and surgical management in facilities that offer in-house stabilization for several hours or days, prior to attempting the hazardous transport of a critically ill person – even when that person is the president or prime minister of the land. If for no other reason than self-interest, a shift of priorities to invest in functional and truly state-of-the-art health care services is worth consideration by the rulers of the land.   Such investment must go beyond good-looking buildings.

Kabale Hospital New Outpatient Unit
Under construction: Kabale Hospital New Outpatient Unit, August 4, 2015

Kabale Regional Referral Hospital recently took possession of two lovely buildings, constructed with a grant by the Government of Japan. The buildings will house a Maternity Unit, Emergency and Outpatients’ Departments and Operating Rooms. This, of course, is worthy of celebration. However, these new facilities need an adequate human resource available 24/7, ready to deal with all emergencies until evacuation to the larger centers.

They need serviced, fuelled and ready-to-go ambulances at all times.  These ambulances should not be transportation vehicles with flash-lights. They must be mobile facilities with highly trained personnel to ensure excellent outcomes for the patients.

This is as true of Kabale as it is of all major towns all over East Africa. The good news is that these essentials are affordable. It is a matter of priorities.

Ambulance paramedical teams with several emergency vehicles: affordably necessity at every hospital

 

 

 

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6 Responses to “State-of-the-art health services an affordable necessity”

  1. Raymond Mukama

    Apparently our government’s priorities are more in instruments that cause death than those that heal.
    Further, our parliamentarians have shielded themselves from paying taxes but they will be using tax payers money for treatment abroad. God save Uganda!

    Reply
  2. G Bhima

    This is an Africa wide malaise. A similar tale could have been told of events from any point of the compass on the great continent. A (medical) doctor and President for life in a country 2,000 miles south of Kabale went to his grave with the reputation that during his rule he had somehow managed to build more prisons than hospitals. Those that he left behind had all been built in the colonial era, before he embarked on his decades long despotic rule.

    His policy was to prevent any native born doctors from doing the job they were trained for. He imported junior foreign doctors who were paid many times more than senior African doctiors. Malawian doctors working in Manchester were said to outnumber Malawian doctors in all of Malawi back in the 1980s. The trend of medical exiles was only partly reversed by building a Medical School and tied doctors up in virtual handcuffs to ensure they stayed put in the country after graduation.

    By the way, it was estimated that despite ruling the poorest country in the world the said late President left behind (in European banks) unrepatriatable funds amounting to over $300,000,000. His chosen means of transport was a top of the range Rolls Royce and contents of his state house rivalled the best some European capitals could boast of. Those are the rumours anyway. When the AIDS epidemic hit that country, the nonxistence of adequate medical facilities wiped out huge swathes of young men and women. At one time over 50% of the antenatal clinic attendees were HIV positive.

    With the good doctor’s head firmly in the ostrich position, HIV decimated families and huge numbers of orphans resulted. Many became ‘street kids’ fending for themselves and their siblings. Some graduated to street criminals and then full time armed burglars. A beautiful country that had once had the gentlest of folk became synonymous with criminality particularly in towns.

    The fall out from a total lack of adequate health care continues to rumble on to this day and subsequent leaders have found the task too much to roll back. They resort to looking after number one. They sweep the problem under the carpet. Once they get their feet under the table they obsess about what executive jet or big limo to buy and which countries abroad to visit.

    Whether they go on these trips to beg for ‘donor’ funds or to shop for designer stuff to put in the ‘state house’ can only be surmised at. Until they get to grips with the dire state of health services, the combination of disease and poverty will for the foreseeable future cap the life expectancy at late thirties to early forties, if they are lucky.

    Reply
  3. Matsiko Kenneth

    This was a Devine interface,but not so many are lucky. Most people are dying on a curse that plagued Uganda thru the corrupt dictatorship here to stay by whatever means. Cry foul my beloved country. May we have the kindness to save a soul in our smallness as we pray that the state rises to the occasion

    Reply
  4. Baryomunsi Nicholas

    Good analysis and pespective to health care.
    It’s worth the investment, because it’s healthy people that drive development.

    Reply
  5. okwanga Joseph

    Mr.Munini, a truly reflective piece about our health situation back home.

    Next time you visit Uganda kindly pay a courtesy call to Atutur, Soroti hospitals.You will the capture the pictures for posterity, and above all emphasize with the sick in this country who cant pay for medical services.

    Indeed our priorities are layered in a way that it benefits the rulers, but supposing then, in the early 40’s, 50’s and 60’s, medical facilities and attention was this callous,some leaders would not be alive celebrating the revenue collections which are spent recklessly without giving human concerns for health for all.

    would I not be right when i say that,” a healthy population is a productive one and consequently more revenues in terms of taxation is realisable from such a population.?

    let’s do something about our health!

    Reply
  6. Asa Ahimbisibwe

    Thank you Dr. Muniini for this insightful and eye opening story. Stories like these ones stopped making news in the Ugandan media, they are simply labelled’propaganda’ if it is put mildly, but on a regular day, they will be called ‘Anti-Government’. The Ruling class has simply learned to shut out poverty, disease, deprivation of the general population behind their gated mansions, and they cushion themselves from the poor road network with expensive cars, and i fear that our MPs have joined the pack, as there is only one way you can make a living in Uganda, become a politician, and when you do, “DO what the High powers say, do not think, do not care, do not listen to the cries of the everyday person.

    Uganda in 15 years, will be at a point, where each one of us has contributed to its state by either ignoring the current injustice and impunity, and choosing to do nothing about it, or by being a part of consolidating the ‘no need to change the status’ movement.

    Each of us, can in our own capacity, contribute to seeking for a better health care for all the Ugandans.

    Thank Dr. Muniini for opening up this space for continued advocacy and sharing of ideas.

    Reply

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