There’s nothing quite like maternal and child health to bring home the realities of living in a country where only 8% of GDP is spent on health care. First, there are the numbers. 435 women out of every 10,000 die in childbirth in Uganda compared to 8 in the UK; 88 of 1000 babies die in infancy and many more are stillborn. Second, there’s the experience of the ward. I saw for myself (at close enough range to catch one) what baby production looks like in the National Referral Hospital - the ‘best’ place to give birth in Uganda. The ward had 20 beds, no curtains, and around 30 labouring women with little or no assistance. I will not attempt to describe this picture any further, only to say there is no way in a million years that I would choose to give birth in that room (if I’m ever persuaded to give birth at all).
So what’s going wrong? The deficiencies in peripartum healthcare unfortunately reflect similar problems across the developing world where funding, human resources and infrastructure cannot keep up with the growing population. The average number of children a Ugandan woman has is 6.7 - one hundred babies are born in this labour ward every day. There are 3 midwives on duty, and one doctor. The intern doctors are on strike because they haven’t been paid for 3 months. The SHOs are taking exams but no one is covering for them.
There are a number of factors that might prevent a labouring woman accessing adequate healthcare. First, she delays seeking care because she can’t afford to get to a health centre; then when she arrives there are no doctors and a clinical officer tells her to go home without examining her; she then puts off traveling to a hospital because she can’t afford it (although care is free, she must bring her own gloves, plastic sheets and scalpel for the cord to be allowed on to the ward); if she can get these, the roads may be too bad to use; if she makes it to hospital, there are 20 other emergencies waiting and she is not seen for 4 hours; when she is finally seen, it’s too late. This is the story of one woman I met and sadly I don’t think it’s a one off.
The Diploma in Tropical Medicine and Hygiene has come to an end. It has taught me a lot more than what vectors transmit dengue fever and how to treat leishmaniasis. Although all that stuff has been incredibly fun and rewarding, the real curriculum has been exposure to the operational realities of health care in developing countries. I might have read about it and talked about it a hundred times, but nothing quite prepared me for how difficult things really are for people who happen to have been born on the other side of the world. Or how tough they are for my wonderful, hard working, intelligent African colleagues who work here – not just for a ‘gap year’ or a ‘sabbatical’ but for life. I don’t claim to understand what this is like but I acknowledge the poor working conditions, the inadequate pay, and the frustration of daily seeing diseases and suffering that although you know what should be done, you can’t do anything about.
And now back to Juba (after a good bit of parental sponsored African holiday). I’m pretty daunted by the next few months working in the emergency ward at Juba Teaching Hospital and by my lecturing rota I’ve just received – flip!… But hopefully I’m going this time a bit more prepared, a bit less naïve and with some new friends in high places dotted around the world to call on when I’m stuck.
Austens on holiday - drinking with the locals
