THE BACKGROUND ISSUES OF THE REMOTE COMMUNITY HEALTH OF NORTHERN UGANDA
This is probably the first ever not-for-profit organization established for the remote communities in Northern Uganda which is focusing on relieving people from the risks of preventable illnesses/morbidity and deaths/mortality. The Northern part of Uganda has suffered a great deal from the impact of four military incursions including those of three military coups and armed conflicts headed by Alice Lakwena and Joseph Kony/LRA. The outcomes and impacts of those upheavals were registered as the establishment of many internally displaced communities, the uncontrollable spread of communicable diseases such as sexually transmitted infections including Human Immunodeficiency Virus(HIV), tuberculosis and skin diseases. Due to the poor social and environmental conditions that were favorable to other diseases the camps were infested with malaria, pneumonia, diarrhea, intestinal parasites, all types of wounds and eye infections. However among children there were more of malnutrition, kwashiorkor and marasmus.
Kids with malnutrition
Children with kwashiokor
A kid with marasmus
The John Bosco Odongo Health Foundation hopes to overhaul the health system completely in the targeted part of Northern Uganda by providing a model community health center and experienced volunteer health professionals to work and provide fee healthservices to the affected population. Since the service will be free-of-charge and there will also be comprehensive health promotion activities the population will be more prepared to make positive changes in their lifestyle including behaviour changes to avoid contracting preventable diseases.
PERSONAL EXPERIENCES WITH THE HEALTH SERVICES IN UGANDA
One may not expect what I am about to tell you about the health services in Uganda to be true, but my personal experiences do unfortunately confirm it. The government of Uganda health divided the health services into five sections namely district hospital, health center four, health senter three, health center two and health center one. The striking thing is that nearly every health service has problems with committed staffing, lack of drugs, inadequate equipment and high rate of corruption practices at every level. In addition the poor access to government health services has been promoted by the practice of coruption, high cost to poor patients, poor management and lack of accountability and responsibility by health service workers.
A few years a go I took my two sisters for reprodcutive health treatment at Mulago hospital, a procedure that would make them not produce children any more, and one of the doctors asked me to go and buy an anesthetic medication and bring to him to use as local anesthesia on my two sisters. However I went and bought the anesthetic drug and gve themto him but he never used them on my sisters. The doctor used the anesthetic drug on other women who privately paid some exorbitant money for the similar surgery. It then happened that contrary to the medical ethics and practice the doctor performed surgery on my two sisters without the use of any anesthetic according to my two sisters and they confessed tha they thought they were going to die from shock as the pain cause by the cutting through their flesh were unbearable indeed as they cried in pain but the doctor just continued with the operation. The procedure was even made worse when the doctor never gave them any pain killer and told them to go and buy some at the pharmacy.
Furthermore during my visit to my village home where my parents live without the supply of electricity, some iron sheets that were stored inside the house accidentally cut my head close to the fore head. I was able to get an emergency treatment from a priest residing in a nearby mission. The following day I managed to go to a district hospital some distance away and on arrival there I met a doctor in-charge of the hospital and explained my situation to him. The doctor never even bothered to check the wound and did not offer me any anti tetanus or antibiotic for treating the wound. A nurse who was nearby pleaded with the doctor to assist me but in vain. I then left for Kampala capital city and went straight to Mulago hospital, a national referral hospital, to see if I could get better treatment for the wound on my head. While at the casualty or emergency department a doctor on duty examined me and prescribed some medication which were to be given to me at the same place by a nurse.
Mulago National Referral Hospital in Kampala, Uganda
When I gave the prescription sheet to the nurse she declined to help me and told me that there were no medicines at the time. I then reported back to the prescribing doctor what the nurse had told me. The doctor then accompanied me to the nurse and instructed her to give me the medications or he would not return to his examination room. The stand off ensued for sometime until the nurse gave in to the order.
Afterwords the nurse unwillingly offered me some wound cleaning and dressing, but I could see on her face that she was not happy to carry on with the tasks on me. The services at the hospital was free and I guess the nurse wanted some kickbacks from me before she could give me any nursing services or the prescribed medications.
The behaviour of the nurse at the emergency department in Mulago referral hospital is typical of what one expects from all or most of the other public health services in Uganda and it is one of the bad health practices that The John Bosco Odongo Health Foundation plans to reverse and address once the planned model community health center is constructed and becomes operational in Northern Uganda.
VOLUNTEER HEALTH PROFESSIONAL STAFF
The JOHN BOSCO ODONGO HEALTH FOUNDATION will be recruiting its volunteer professional health staff from all over the world through our partners and collaborators. The organization will be responsible for their accommodation, security and welfare while they are working at our health facility. The volunteer services will also be opened to universities who may have final year students who may want to come and learn about tropical medicine and diseases from a remote community of third world country perspective.
In addition universities may come and carry out research at our health facility provided certain conditions such as ethical approval can be obtained for their project. In this case the organization will offer logistical assistance and support to such interested researchers and research institutions. However once the health facility is operational we can be contacted through our appropriate channels of communication listed on our Website or through our regional partners and collaborators.
THE COMMUNITY HEALTH PROBLEMS OF NORTHERN UGANDA
The remote communities of Northern Uganda where the proposed model community health center will be built is situated in areas previously devastated by internal conflicts such as those of Alice Lakwena, Joseph Kony, military coups of Idi Amin Toto Okelo and Yoweri Museveni – all of which occurred between 1971 and 1986.
The conflicts caused many people to be internally displaced, many were killed, others were kidnaped, maimed, disfigured while other people fled the country for their safety. The problems also caused many services such as the justice system, schools, even distant health facilities and other social services to disappear. As a consequence people resorted to primitive and unhealthy ways of life. For instance, any expectant mothers were being attended to by untrained traditional birth attendants, people suffering from diseases such as malaria, typhoid, diarrhea, pneumonia and wound infections had to be attended to by traditional herbalists and witch doctors with unpredictable consequences.
Internal displacement of people of Northern Uganda due to internal wars and conflict
It is unfortunate to observe that the health system in the remote areas of Northern Uganda has not improved, and could be getting even worse, although the government insists that it has established health centers to the village level from health center I(one) to health center IV(four). From what I have witnessed the health services being claimed by government are only by name since no viable health services are operational. The remote communities still continue to suffer from the lack of easily accessible and affordable health services. People are still dying from preventable causes and due to lack of immunization and effective early intervention.
The current health system is heavily corrupted, only physically available in some areas, and no medicines, equipment or health staff who are willing to work at the health facilities and instead spend their days in privately operated clinics which are located far away from the remote communities where they get more money. What the people from the remote communities want is a reliable, affordable, easily accessible, comprehensive and effective health service. If all goes according to plan, it is being hoped that The John Bosco Odongo Health Foundation will be able to provide a complete solution to the health problems of those people living in the remote communities of Northern Uganda. This is so because the work of the organization will strictly be guided by its mission, values, goals and objectives.
HEALTH CHALLENGES IN COMMUNITIES OF NORTHERN UGANDA
Before Uganda became independent in 1962 the country was a British colony and then later a British protectorate. The British rulers in Uganda used northerners in the armed forces because they believe that the men from there were good at fighting and were fearless. At the same time the British rulers never developed the Northern region of Uganda economically and educationally so that many Northerners were illiterate and uneducated. The road infrastructure in the northern Uganda were without tarmac, educational standards were very low and poor and the law of the jungle were prominent everywhere. Furthermore quack doctors, witch craft, witch doctors, herbalists and naked night dancers were in every village. In addition most people did not have money to use to pay for bills, and resorted to bartering trade as a means of doing business.
When traders such as Indians and Nubians arrived in Northern Uganda people were able to get some cash once a year from the selling of cotton to the Indian-managed cotton factories. Furthermore Some Indians also set up shops and employed local Africans to assist them with translation of local language. The Indians were able to sell on the counter some pain killers and flue medicines such as Aspirins and Aspro. Those people with sexually transmitted infections, ulcers, leprosy and tuberculosis were not able to get appropriate medicines so easily.
However some missionaries began to assist those people with leprosy, and quack doctors attended to people with sexually transmitted infections. There were other conditions which people believed were the result of being bewitched and the victims approached witch doctors and herbalists. Sometimes when untreated syphilis disseminated and became complicated or affected the brain most people thought it was due to witchcraft and resorted to seeing a witch doctor or herbalists who undoubtedly failed to manage the problem and the situation got worse.
As you can imagine, a combination of being uneducated, poverty, ignorance, cultural taboos, cultural beliefs and practices – all contributed, and still does contribute, to the health problems of the communities of Northern Uganda. It will therefore require a holistic approach to overhaul the current health status of the suffering people in the communities of Northern Uganda. I guess one of the interventions is to change the people’s cultural beliefs to the current or conventional health approaches. This may therefore require raising awareness about health promotion at the individual, family and community levels. The health promotion issues could include personal hygiene, healthy food and food hygiene, environmental safety and health, preventive health and curative health.
When the community health center will be constructed and becomes operational its services should be free or affordable in order to bait the poor community people to present to the health center to ask for services. However a sustainable health promotion activities will have to be the rule as it will take time for the majority of the communities to understand and begin to appreciate the benefit of conventional health services as opposed to their cultural practices.