Reading your e-mails has been a treat. Thank you all for being so supportive, making request, giving me direction, requesting photos etc. I guess you all prefer e-mailing instead of commenting on blog. Maxime, thank you for requesting I post a link to donate to Kissito. It’s in the works. Hatim, thank you for sending me Fiona’s latest album. Perfect timing for today’s long and bumpy ride. Oh, and good call on the Mophie, very handy. Had I not had it today I could not have brought you guys these great c-section videos.
A lot of you have asked me to break down the health care. It’s hard to do without making these post long and tedious, but here’s the basics…
It’s no secret Uganda’s health care system is cracked. The government allocates 9.3% of total national budget to health care. So they claim. Uganda’s healthcare performance is still ranked as one of the worst in the world by the World Health Organization. The country is ranked 186th out of 191 nations. A Ugandan’s life expectancy is among the lowest across the globe. In Uganda, one in every 200 births ends the mother’s life, around 1 million people are living with HIV and although malaria accounts for 14% of all deaths, less than 10% of children under five are sleeping under insecticide-treated nets. There is a hierarchy to the health system. The clinics are rated levels 1-4, General hospital, Regional hospital, and then National hospital. I personally cannot tell a huge difference between the levels as they are all lacking. Level one does not have a structure. Picture someone in a village who can distribute basic medicine (pretty non-existent) Level 2= small structure(building) where common diseases are treated. Level 3=treats basic disease and has a maternity area with midwife. Level 4 treats diseases plus maternity, plus surgery. Our level 4 is Bugabero clinic(c-section videos happened here). Next step up is a General hospital (similar to level four) Our’s here is the Mbale, regional hospital. The only National hospital in the entire country is in Kampala. This is where one goes to see any specialist. One in entire country!
Don’t picture any of these clinics actually functioning like anything you’ve seen in the U.S. For example, the government might come in and build a small structure, supply a few beds, minimal meds, and employ a few staff, but they don’t actually show up. The places literally sit empty. When paid by the government no one monitors if you show up for work. Many employees have to walk miles to work (not much incentive) and don’t have the staff or infrastructure to run effectively. For example, Wanale clinic was built three years ago (it’s still empty).
Kissito (and standard NGO protocol) come in, supply meds, equipment, staff, trains staff, and generally try to get the place to actually function. To do this, NGO’s have to offer “Top Up’s” which is a performance based bonus pay on top of government salary. Reform is slow. Pay is based on skill. The head nurse at Bugabero makes 800,000 shillings/monthly=400 dollars. Most staff makes around 175US monthly from Gov’t (gov’t jobs are known as shit here). The employees hired by gov’t don’t have access to monies to supply adequate care. Most drugs disappear, and record keeping is a horribly dated and inaccurate. Everything is hand written and carbon copies is a new concept.
The first day I traveled to Wanale clinic, Robert (clinical officer) explains that the meds are locked in a box and he has not been able to get the key. Easy right, we’ll get the key. Don’t think like an American, were in UGANDA. His superior, (hired by the gov’t) is the only person allowed access to the key. Sadly, he never shows up, and when he does the med count is questionable. In this culture you don’t question your superior. To override them or have someone fired could take years, a painful arduous process requiring the Ministry of Health. That’s where NGO’s save the village. And, the money comes from big-hearted donors like you/us. We don’t make the rules, we suffer through them along with everyone else. I can tell you NOTHING would happen without them, so you can understand there is constant drive for funds…and yes, if we sacrified one bar night out, a fancy dinner, a new pair of Italian boots, and send that money here it literally saves 10 or more people’s lives. Money goes a lot further here. Who’s gonna start a Nat’l health fund on Kickstarter? If we all gave 5 dollars a week…
So, enough of that for now. This would be more interesting if I had a beer, but that’s against house rules. On the flip side, there are a lot of amazing people here working hard for their community despite being paid nothing, like Dr. Sabiti. He sleeps less than 5 hours a night, is always smiling, performs surgeries around the clock, drives hours around town, working hard. He expects to be in the Ministry of Health in 5 years. He has my vote! Many of the staff he supervises walks 4 plus miles to their clinics, and are honored to work under his supervision, learning better ways.
On the bumpy non-tarmacked roads we head out to 5 clinics today. Yeah, more bad, and I mean BAD gospel music in Spanish. Tyler moans from hours of being jolted around. Dr. Sabiti’s witty banter keeps us laughing. He starts asking us how often we look at our private parts in the mirror. Oh, yes, I found my tribe! I think I have this on video. We see Michael ( a clinical officer) walking on the side of the road. We swerve over and tell him to get in( his clinic is 5 more miles). Dr. ask him immediately, “How many times do you look at your private parts in the mirror.” Without skipping a beat he answers, 1 more hour of entertainment. Great minds think alike!
Last stop is Bugabero clinic, level 4. Dr. grabs me to observe an emergency C-section before we head home. We run back to the “theatre” which is what they call surgery rooms here. I’m asked to take off my sandals and put on a pair of crocs. Interesting. I throw on scrubs and enter. Everyone is laughing and surgery starts with Dr. singing a prayer. I confidently get my I-phone ready to record. Let’s do this. I’m asked to pinch the patient’s throat as the nurse is shoving the breathing tube down. I can feel the tube entering her body as she tells me to squeeze harder. Dr. starts cutting and I’m suprisingly fine. I pan around as the nurses are checking their phones and giggling. His incision hits the uterus and water squirts across the room. Blood starts pooling between her legs. He starts pulling her flesh apart similar to stuffing a turkey. The room started closing in on me and I felt reality slipping. I left the room three times to avoid passing out. My apologies for the series of bad videos. By the end of this month I suspect birthing will be routine. Whatta day! Here you go!
Our crew jokes a lot. One of the running jokes around here is that Tyler is “uncircumcized.” That’s a heated topic around here. Bamasaba tribe believe circumcision is a right of passage into manhood. When a boy is 16 or so they are circumcised by a smaller knife/machete. Before HIV awareness was introduced into the scene the same knife was used on everyone. Now each person gets a new knife. This still happens but not amongst most people here. When Tyler went to the hardware store the man behind the counter asked “Are you circumcised”? He answered, “yes”, although he doubts the man thinks he has been indoctrinated into true manhood b/c it was done at birth. I keep trying to find items we might need to send Tyler back to the hardware store. 🙂 Lots of circumcision puns( by locals) around here.