37th is better than 149th: Experience working in Kampala, Uganda
Hi all- I’m Sara, the new summer intern at change:healthcare. I’m only two weeks in, but it has been great so far! Katrina asked me to write a blog post about anything my heart desired involving healthcare. So, I’ve decided to share some of my experiences from the last four weeks I spent doing medical work in Kampala, Uganda. This blog presents a unique opportunity to express some of what I experienced because most people only want to know if I saw a lion or if it was scary. While both of my stays in Africa have been full of adventures (like a safari during which I did see a lion, bungee jumping over/rafting the Nile, and climbing Mt. Kilimanjaro- no big deal), these in no way sum up my time there. This summer my work helped me understand the flaws and successes of the Ugandan healthcare system. I worked at a place called Meeting Point (MP), a rather unique site assignment. It is hard to sum MP in one or two words because it provides so many services to the surrounding community. The assistance MP provides includes adherence counseling; home visits to their HIV positive clients; a welcome home for 40 AIDS orphans; vocational education for older children who never received any formal education; and primary level education to local children. They also supplied food to many of their clients until the resources they received from the World Food Program (WFP) were cut due to the need in the Northern region of the country. Obviously, they cover quite a bit of ground.
Part of my daily routine consisted of accompanying an HIV counselor on home visits in the communities surrounding their offices. Over the course of four weeks, I must have visited over 70 homes and families. The complaints of most involved hunger due to the lack of support from the WFP or the need for school fees to keep their children in school (MP also sponsors hundreds of children’s school fees). I learned so much about the indirect effects the HIV/AIDS epidemic has on the lives of those affected. I met numerous parentless families where children were fending for themselves or families run by grandparents who are now responsible for multiple generations of children. I often met women left caring for as many as eight children on their own due to abandonment (Uganda has the third highest birthrate in the world with a fertility rate of 6.6 children per woman, so large families are the norm). Talk about being a single parent. It was not until I visited a woman named Miriam on my third day of home visits that I saw firsthand the devastating effect HIV/AIDS could have on a person physically.
Miriam is a woman in her mid-twenties who is HIV positive and has developed tuberculosis because of her weakened immune system. She has been taking both antiretroviral drugs (ARVs) and TB medication for the last four months. The combination of ARVs and TB meds has had a significant effect on her mobility and strength. When I visited Miriam, she could only sit up in her bed and her entire collarbone and all her ribs were visible. The combination of both powerful medications has resulted in peripheral neuropathy (paralysis) on the left side of Miriam’s body and she said she could feel the right side of her body succumbing to paralysis as well. Sitting up took nearly all of her energy. She knew she needed to get to the hospital because of her weakened state, fever, and because her lungs were filled with fluid, but she didn’t have money for transport or any phone credit to call a MP counselor (keep in mind, transport to the hospital would cost roughly 5 USD and a phone call 20 cents). She simply had to wait for someone to visit her. Luckily, the day after our visit the staff arranged for Miriam to go to the hospital to receive care.
While Miriam was the first of many HIV/AIDS patients I met who were suffering a great deal physically, there was a common thread connecting all of their situations- a lack of access to care due to physical and economic barriers. Without the help of the MP counselors and community workers, it is unlikely many of the clients would be able to access the care they need. While numerous HIV/AIDS programs throughout Kampala provide free clinical services and medications, (the running joke is that there are more NGOs than children), what good are they if the services are not accessible? This issue of access does not pervade only the developing world. US residents of urban areas with poor public transportation systems or of scattered rural areas also experience difficulties accessing care. Citizens of both countries face varying levels of economic struggles to receive healthcare services as well. An HIV test at one of the private hospitals in Kampala costs 20,000 Uganda shillings (roughly 9.50 USD), but the average Ugandan makes less than 30 USD each week. If the choices are getting an HIV test or feeding their children, which do you think they will choose? Luckily, MP has worked to overcome both of these barriers by getting out into the communities and ensuring their clients can gain access to the services and care they need. This practice of meeting people where they are has been the hallmark of the work and projects of Partners in Health, who initiated a similar project here in the US to assist marginalized HIV patients in Boston. Learn more here. (Remember, HIV/AIDS hasn’t skipped over the US. A report published by the District of Columbia’s HIV/AIDS Administration just a few months ago estimated that 3% of people residing in the nation’s capital are HIV positive. Check out the report here.)
While the US healthcare system is anything but perfect, my time in Uganda made me appreciate our system as broken as it may be. The battle against HIV/AIDS in Uganda is one of the continents greatest successes with a national infection rate of “only” 5.4%. Rates, however, are increasing and experts are working to understand why. While I can do a fair bit of complaining about the cracks and flaws of our system, witnessing the healthcare struggles experienced by those in the developing world has definitely given me a new perspective as to how lucky I am to have access to the 37th best healthcare system in the world. (Uganda is ranked 149th out of 190 by the WHO.) To learn more about the current HIV/AIDS situation in Uganda and worldwide, you can check out the UNAIDS 2008 Report on the global AIDS epidemic.
Some of the students who attend MP's primary school.
My place of work for four weeks in the district of Namuwongo.
