Day 12: Bugweri

This was a really packed day. It was rounding up to be one of our last days in Jinja region and we were aware of our opportunities here coming to an end. We wanted to make sure that we touched on the lower HCs - HC-IVs and below. With Darius’s connection, we were able to have access to the HCs relatively easily.

Darius worked with some of these locations to collect data. District Secretary Office (DSO) operates at the district level to collect data from lower tier facilities. This is the first point of aggregation of healthcare data for the Ministry of Health (MOH).

Bugweri HC4

We rolled into an open campus at Bugweri and were surprised to be greeted with a quiet, serene field. A row of buildings lined the top of the shallow slope. A gate to the right of us led to the DSO. A truck from the National Medical Store was parked outside the storeroom and boxes were being unloaded and checked. We greeted the store manager who was busy at the moment and instead headed to the DSO first to speak with the staff there.

In the past week, we have heard of shortages on a daily basis - shortage that led to referrals out of hospitals, shortage that led to empty referrals at receiving hospitals - and we wanted to understand what was the supply system behind these logistical issues. Outside the DSO office, we brought out chairs and laid them in a circle under a tree - it was a perfect picnic interview outdoors. We found out that healthcare data was uploaded every week, and supplies were ordered based on the demand seen from the healthcare data. However, physical supplies only come in every 2 months and they often come in at lower quantities than what is ordered. Often, the supplies run out within the first 2 weeks and patients are requested to purchase their own supplies from outside the hospital. This can range from drugs, gloves, and plastic mats for examination bed hygiene. Experienced patients prepare for this - I saw this from the first day of observations when a patient pulled out a pair of examination gloves from her bag.

When we headed to the antenatal ward, we were the only ones there. We know antenatal wards to be conducted earlier in the day, but it was before noon and the benches were empty. This is in stark contrast with Iganga and Jinja. We would soon discover that the only healthcare worker present in the wards was a single midwife. We conducted a short interview with her, knowing how much work was on her shoulders alone. She told us unsurprisingly that the healthcare workers here play multiple roles - midwives would double as anesthesiologists with minimal instructions when emergency cases occur (we would later be told that spaces would play multiple roles as well). Sometimes, surgeons would not be present and patients would have to be referred. There was a large gap caused by the lack of coordination of personnel and resources, and it shocks me to think about the 30 minute travel a patient in critical condition would have to make to get to the nearest facility in Iganga which we have seen to be better equipped.

Bugwosi HC3

It was another 20 minutes drive to Bugwosi HC3. We broke off the main road and hit a narrow, unpaved roadway where we would be greeted by panicky goats tied to a stake on each side of the road as our van rolled by. We took one branch and then another - I have no way to know how Darius and Waiswa, our driver, knew which way to go. Nonetheless, we stopped outside a small building where patients would be triaged. The biggest thing we observed was that HC3 did not have an operating theater - that meant any patient who require surgery would have to be referred.

We entered a small room with cemented floors where we were greeted warmly by the in-charge. The space was narrow, but multiple examination rooms stretched into the back of the building. It was mid-late afternoon, and it appears that the clinic was done seeing its last patient.

Again, we visited the antenatal clinic - a dedicated building to the side of the main clinic. There, the midwife greeted us. The antenatal clinic was also done for the day. The antenatal clinic was empty besides the midwife who ushered us into a small space in the corridor leading to a small room that served as a labor ward. A small autoclave about the size of 3 large kitchen pots stacked on top of one another sat in the corner of the wall. We discussed how antenatal care was like and discovered that much the same procedure was followed throughout different tiers of health centers. However, the entire antenatal clinic only had 2 or 3 nurses available at each time. The lack of personnel and expertise is usually an impediment to the mothers receiving the full course of examination.

Dinner with Iganga doctors

The evening was coming upon us and we had scheduled ourselves for dinner with the doctors at Iganga hospital. A total of 6 doctors showed up, with Dr. Edson leading them. In our conversation over dinner, we learnt about why maternal care is at higher stakes - doctors are treating patients who are healthy but could at any point in time take a turn for the worse; In contrast, doctors in other specialties usually deal with patients who were already sick. This puts additional pressure and scrutiny on doctors if patient treatment outcome were to suffer. Dr. Edson points out that maternal health would possibly be the toughest rotation that an intern would go through in their year of training.

Moreover, only 10% of interns are hired by government hospitals every year. Dr. Edson pointed out that due to the lack of funding available, most doctors turn to the private sector. It was competitive to get into private practice, and most doctors turn to a different profession after their 6 years of comprehensive training. Some turn to public health working with NGOs and others go to countries like Qatar to work low-skilled jobs like construction because they get paid more that way. It is unfortunate that Uganda has so many trained, talented doctors turning their backs on the profession that they have trained in for money and survival. It is wild to think that an estimated 80% of doctors churned out by medical institutions every year would walk away from what they spent student debt and 6 years training for. This is a huge cost not only on the medical students but society itself that desperately needs their expertise. I took a look around the table, there were 6 talented doctors seated around me. Dr. Edson wants to specialize in maternal health; another is a national basketball player who is disappointed with his internship experience thus far. All of them are pursuing medicine and patient care because of a passion for patient care and the betterment of health in their community. We ended the night parting with our friends at Iganga on that thought.