Uganda: The challenge of healthcare in remote Buliisa
By: Davinah Nabirye, Communications; World Vision Uganda
Amidst the scorching mid-day sunshine, Ruth Nyangazare, 38, carrying her two-month-old son Kaleb Taremwa in her arms, arrives at Buliisa Health Centre IV’s maternity ward, in western Uganda. Judging from the sweat flowing down her weary face and the dust covering her feet and sandals, she seems to have traveled a long distance.
The maternity ward is an open four- walled room occupied by seven beds. It serves as the admission ward for mothers waiting to give birth and for those who have just delivered. It also doubles as the waiting room for pregnant women seeking antenatal care services and immunization for their children.
In the corner of the ward closest to the entrance is one bed - used as both the desk and the examination table for recording patient data. It has books, paper and a few instruments such as a sphygmomanometer (a device used to measure blood pressure) and pinard horn (used to listen to the heart rate of a fetus during pregnancy). The small room opposite this fits two chairs and a table, and is the only place to go for a private conversation between a nurse and a patient.
Yet this Health Centre IV, typical of many in rural Uganda, is the biggest health facility in all of Buliisa. Approximately 280km from Uganda’s capital Kampala, the district operates just 10 health centres to service a population of 130,000, more than 50% of the population aged under 18 years and 27% aged under five.
Twelve pregnant women are sitting on two wooden benches placed in the corridor between two rusty, old, metallic beds. Five other pregnant women are sitting on the beds. Each of these women is waiting to be served by the nurse on duty. Two newborns - a one-day -old baby and a seven hours’ old baby - occupy the extra beds.
The ward is too small to accommodate the large number of patients needing the service. According to Scovia Saturday, the in-charge Maternity and Nursing Officer at the health center, “On average, in a month, 40 women deliver from the facility while 250-300 women receive antenatal services.”
Shockingly, the district has only one doctor, who has only just arrived to take up a position that has been vacant for over four years.
Shockingly, the district has only one doctor, who has only just arrived to take up a position that has been vacant for over four years.
Dangerous home delivery preferable to clinic or hospital
Although records kept at the maternity ward show that many women seek antenatal services, fewer women deliver here. The facility is mandated to provide child delivery services but lacks a resuscitation machine that is critical for babies who need assistance breathing at birth. Scovia explains that when a baby needs to be resuscitated, they must simply try to clear the baby’s throat with their fingers.
The surgical theatre is in a dilapidated state and has not been used for over five years now. The theatre neither has running water nor electricity, and so all minor and major surgical cases are referred to the main referral hospitals in the neigbouring districts of Hoima and Masindi.
But accessing the nearest referral hospitals is also a nightmare for the people in Buliisa. The ambulance stationed at the health centre is driven by a volunteer who is sometimes unavailable when needed. When the driver is accessible, patients must meet all fuel costs around Ug.Sh.150,000 (USD 57) – far too expensive for the subsistence farmers who make up the majority of this population.
The remaining option, which many women continue to take, is high risk at-home birth. This has sustained and supported the illegal industry of Uganda’s traditional birth attendants (TBAs). TBAs were banned in 2003 because they rely primarily on experience and knowledge acquired informally through the traditions and practices of their communities - some of which can put lives of the mother and baby in grave danger.
Scovia reports that TBAs still attract mothers who would rather not travel the distance to a proper hospital. “Some women live as far as seven kilometres away so when in labour, they prefer delivering under the assistance of the TBA.”
Low rates of immunisation for infants
Today, Ruth has endured the hot weather to bring her child for immunization. “The nurse told me to make sure that I immunize my son to prevent diseases like polio and tuberculosis but coming here every time is difficult,” says Ruth.
Rates of full immunisation in the child’s first year are low in Uganda. According to Ministry of Health Uganda Routine Immunization Coverage report for July to September 2013, statistics show that utilisation of immunisation services, and not necessarily the services themselves, may be to blame for this. Combined with regular drug shortages and a chronic lack of trained medical staff, this means that Buliisa district continues to lose its children to preventable diseases such as pneumonia, diarrhea and rampant cholera outbreaks.
These diseases can also affect adults, sometimes with devastating results. Helen Anyesige, 22 years, is one of the women waiting on the wooden bench at Buliisa Health Centre 1V. A week ago, 3 months into her pregnancy, Helen miscarried. Now she has bad pain in her lower abdomen. She was told that malaria could have been the cause of the miscarriage but she will probably never know for sure.
Similar challenges across rural Uganda
The challenges to accessing quality maternal and child services in Buliisa provide snapshots of the health situation in most areas in rural Uganda. Solutions lie in the hands of citizens, decision makers and the government - and they must find ways to work together more effectively.
William Kiiza is World Vision’s Programme Manager in Buliisa cluster. He says, “ To reduce the health challenges in Uganda, efforts towards improving maternal and child health services need to be strengthened by the decision makers and implemented by all partners.”
“Now is the time for the Ministry of Health to fulfill commitments to improve the lives of mothers and children such as ensuring that the UN endorsed 13 life-saving drugs are available in all facilities that should have them,” William added.
For more information about the UN Commission on Lifesaving Commodities click HERE.
Read the World Vision Uganda special report: 'Gone Too Soon, Can Something be Done? Ugandan mothers share stories of their children's deaths.