Healthcare in Western Uganda: what it’s like to live a long way from anywhere
Save the Children writer Ben Brill visited Uganda in December 2015, to see Save the Children’s work in the country. As part of a series of three blogs, here he writes about his experience visiting healthcare facilities in the Western region.
The edge of Lake Albert. The edge of Uganda. Miles and miles of silence all around us. Flatlands and scrub and a new, harsher kind of heat. In the afternoon sun, it saps the energy from your bones the moment you step into it.
There are people here – paddling out from the shores of the lake to fish, or farming small patches of land in front of exposed grey concrete homes – but they’re spread out, and hard to come by.
To live out here is to live without electricity and with an erratic water supply. Food comes from a fortnightly visit to the nearest market, in a town we passed through on the way here, forty miles away.
It’s a three-hour drive, along a route that is more crater than road. In almost every way it feels like an eternity.
The Save the Children-supported healthcare centre here in Rwangara district is the only facility like it for miles. It serves around 24,000 people, all dotted around this unwelcoming landscape. If they get sick, this is where they come – and sometimes, that means walking for a whole day to get here.
At the start of 2015, their destination would have been a single tiny building. It was understaffed, under-equipped, and unable to meet the needs of the community.
Mothers-to-be had it particularly hard. There was no dedicated maternity ward, so they were giving birth in a cramped, airless room filled with sick patients, putting them and their newborns at terrible risk of catching new illnesses at the most vulnerable time.
It was no place to bring a new life into the world – but then, with no other centres for miles around, what choice did they have?
Just part of the story
When Save the Children talks about reaching the hardest to reach, we’re talking about places like this. Places that don’t show up on maps. Places that, as Richard, the man who oversees Save the Children’s maternal healthcare work in the region tells me, even local leaders seemed to have forgotten.
“These communities were so far off that they [local politicians] imagined that no one was travelling to them,” he tells me. “So you’d end up with these facilities where no one was taking care of them.”
Save the Children provided funding to improve the facilities, and in July 2015, a number of new buildings opened, including a dedicated maternity ward, waiting rooms and cooking facilities for visiting families, as well as living quarters for the staff.
But the blue and white buildings that Richard proudly shows us round are only part of the story – alongside that comes years of tireless work to make sure that the opportunity a new building presents isn’t squandered.
Richard: an inspiration
Richard’s been working for Save the Children since 2012. Talk to him for just a couple of minutes, and you realise how this is much more than just a job to him.
“I have this drive,” he tells me, explaining how he paid his own way through medical school by teaching biology and chemistry to high school students before emerging determined to work in deprived communities.
He speaks softly but passionately about his work out here, as he reflects on the situation he faced when he first joined the team.
“The facilities would be there,” he says, “but because of challenges like access, and a lack of services around the facility, no services were being offered to the community.”
“Some of the communities had really lost faith in the health system. They knew there was nothing the government would do to help them out.
“We began doing outreaches, targeting hard-to-reach communities – we’d travel for three to four hours to find people who were willing to take up these services.”
Richard explains how they set up health teams to work within villages, making sure that even the most isolated could access healthcare.
Sometimes that meant providing outreach services such as vaccinations, or even helping to pay for a motorbike so that villagers could get to nearby facilities – whatever it took. Slowly but surely, demand for the healthcare services on offer started to increase.
The next challenge was meeting that demand – and making sure enough health workers were on hand to provide decent care.
A shared vision
It’s tough finding people who’ll work in places like Rwangara. Health workers plying their trade in hard-to-reach areas earn no more than those in cities and towns, where life is more comfortable. If a facility doesn’t have living quarters for staff, or if it’s underequipped, it makes it even tougher to attract staff.
The solution, Richard says, is “to share the vision. So you put aside looking at this job as a source of income and look at it as an opportunity to create a difference in the community – an opportunity to serve the community. Then you have that shared goal and shared vision.
“Making people part of the change that they want to see – that alone is a motivating factor to them.”
Reaching the hard to reach
Across the district, the strategy is starting to pay dividends. But at Rwangara, it’s still early days. The facilities are there, but the staff are yet to arrive.
Estate, the slight 26-year-old midwife who manages the centre is optimistic though. “If Save the Children were not here, attracting health workers would be too difficult,” he tells me. “Their effort has helped this community.”
Even when the centre is fully staffed, there will still be challenges. Pharmaceuticals will still be in short supply – demand for government deliveries is so high that supplies run out within weeks.
And pregnant women in need of caesareans will still need to travel forty miles back along the bumpy road to the nearest town – a difficult journey when you’re travelling by 4×4, but an unimaginable one on the back of motorcycle.
Things are improving, but life will always be tough in isolated communities like this. If organisations like Save the Children weren’t reaching out though, they’d be on their own.
“Lots of other organisations just want to do what others have done,” Richard says. “But Save the Children always goes to the places that have not been reached, to try to tap the untapped. That’s what makes us unique.”