Woman at health center with ONP education posters.
As you know, PHP recently launched the Omukazi Namarara Program, thanks to the generous support from all of you. I'm pleased to be able to report that the program is continuing to go very well. The people in Kashongi and Kitura, our partner communities, have fully endorsed the new services, and we're laying a strong foundation for the future as we aim to improve maternal and neonatal health.
Despite the progress, we're still far from solving all of the maternal and neonatal health issues in Kashongi and Kitura. In this message, I'd like to share a story with you which I feel provides a good illustration of the enormous problems we're up against. I think that those of us who are interested in eliminating maternal and neonatal health disparities can learn much from this story. The story follows.
One day a woman, who I will call Jessica (who has given me permission to tell her story), arrived at the government health center in Kashongi to give birth. She was 17 years old and had been working as a maid for a wealthy family in the community. This was her first pregnancy, and she had just had her first antenatal visit about one week ago. She was one month premature, and her membranes had ruptured before labor. The midwife instructed her to go to the Mbarara Regional Referral Hospital, located about 45 minutes away by car, because she could not handle the case.
The man who had impregnated Jessica had left her. She was completely alone at the health center. Her family lived about 30 minutes away by car, and she had no way of communicating with them. With the little money she had, she paid a motorcycle driver to visit the family she had been working for and ask for help. The family told the motorcycle driver that they were completely finished with Jessica and had no interest being involved in her life.
Jessica stayed behind the health center, in pain, at times laying in the grass and at times standing with her arms folded -- scared, ashamed, and lonely. My colleague and I had a car, so we decided to take her to Mbarara. On the way, we picked up her mom. When my colleague went to the family’s home, her mom hesitated, complaining that she had just been in Mbarara with her own sick baby, and now she did not have a single shilling. My colleague assured her that we would handle the costs, and she then came quickly.
As one reaches Mbarara, the first thing he or she will see is Lakeview, a huge luxury hotel. Most people from “the village” -- that is, the rural areas -- never come to Mbarara. I could only imagine what Jessica and her mother were thinking as we drove into the city. I always knew a significant disparity existed, but this occasion put it into stark relief for me.
When we reached the hospital, we brought Jessica to the admitting doctor on the obstetrics ward. “Do you have a plastic sheet?” were the first words out of his mouth, referring to one of the many supplies women themselves were expected to bring for their deliveries. He then told us that there were no beds left in the antenatal room, so Jessica would need to sleep on the floor and would therefore need a mattress. As Jessica and her mom got “settled”, my colleague and I left to buy a mattress and sheets.
When we returned, her mom was holding a sample of blood that had been drawn from Jessica. They were waiting for us so they could figure out what to do with it. We spoke to the doctor, and he said that a complete blood count and a blood smear to test for malaria were needed. The hospital did not do those tests, we learned, so we would need to take the sample to a private lab. I asked whether the doctor could use the Poor Patients Fund, which I knew was available at the hospital, to cover the cost. He responded that the Poor Patients Fund was only available on the medical ward and that the obstetrics ward was predicated on “survival of the fittest.”
We first took the sample to a discounted lab affiliated with the hospital that was located on the same grounds. But we were turned down because the lab’s machine was broken. We then drove the sample to a private lab in the middle of town and received the results within about an hour. At this point, if not earlier, a poor person from the village would have been utterly lost. Mbarara was like a foreign country to them, with many people speaking English and a completely different way of life. Moreover, the class differences between the health workers and the villagers were striking.
We brought the test results back to the hospital. It appeared that Jessica had a bacterial infection, but a doctor would not be available to interpret the results until the next day. When I visited Jessica the next morning, she still had not given birth. The ordeal had now been going on for over 30 hours. I began to lose hope. I asked a nurse to please make sure she was taken care of, and I left for work. I returned in the evening; miraculously, I found Jessica and her newborn baby. They were doing well, all considered.
In addition to showing the paucity of basic public health services in Uganda, Jessica's story shows what it is like to navigate the healthcare system as a poor patient. With all of the obstacles poor people have to confront, virtually every element of the system is stacked against them. These are the kinds of problems that PHP is working to address.
Jessica was extremely fortunate, but other women are not as lucky. There is no reason why, in the 21st century, so many women should continue to die from childbirth-related causes and so many children should have to grow up without mothers, all because of simple, solvable problems. PHP is exerting all of its power to implement solutions to these problems -- because accessing decent healthcare should not be the monumental challenge that it currently is for the poor.
As we enter the holiday season, let's be thankful for everything that we have and make commitments to support the betterment of people's lives elsewhere. PHP continues to deeply appreciate all of your generous support toward this end.
Mosquito nets at health center installed by PHP.