Category: Uganda

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Why Don’t We Have a Global Fund for Maternal Health?

Well, cause someone would steal the money anyway. No? Ok, how about because the international community is preoccupied (is obsessed too strong a word?) by the much more exotic sounding tropical and infectious diseases (a virus that turns your insides to mush = exciting/terrifying, bleeding to death giving birth = boring). Not everyone gets Ebola or HIV or malaria, but most people either give birth or are the direct cause of someone else giving birth (and if nothing else, at least someone once gave birth to them). So maternal health is ordinary, banal, and just plain not-sexy. That is, unless it is tied to something exotic (see Prevention of Mother-to-Child Transmission of HIV — PMTCT)…

The wards described in the article of the Tanzanian hospital are not different from those in Uganda. In Mugalo Hospital, around 80 to 100 babies are delivered every day, and there are certainly not enough beds for all the mothers. One medical student working in the labour ward described to me how the “fluids” from one mother giving birth flowed into the ears of another mother who was sharing her mattress one night during his shift.

I don’t know what the solution is to the neglect of maternal health. In Uganda, maternal mortality statistics have barely budged in the past 20 years. The 2006 Uganda Demographic and Health Survey (depressingly) discusses the lack of improvement with regard to maternal mortality:

At first glance, it would appear that the maternal mortality ratio has declined significantly
over the last five years, from 527 maternal deaths per 100,000 live births for the ten-year period prior to the 1995 UDHS to 505 for the ten-year period before the 2000-01 UDHS, and to 435 for the ten- year period before the 2006 UDHS. However, the methodology used and the sample sizes implemented in these three surveys do not allow for precise estimates of maternal mortality. The sampling errors around each of the estimates are large and, consequently, the estimates are not significantly different; thus, it is impossible to say with confidence that maternal mortality has declined. Moreover, a decline in the maternal mortality ratio is not supported by the trends in related indicators, such as antenatal care coverage, delivery in health facilities, and medical assistance at delivery, all of which have increased only marginally over the last ten years.

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No one cares about our nations more than we do

We appreciate support from the outside, but it should be support for what we intend to achieve ourselves. No one should pretend that they care about our nations more than we do; or assume that they know what is good for us better than we do ourselves. They should, in fact, respect us for wanting to decide our own fate.

Says Kagame in his op-ed last week in the Financial Times.

While I am concerned that certain individuals high up in the echelons of power actually care about themselves far more than their nations, I agree wholeheartedly with Kagame’s sentiment. Especially the bit about supporting a country’s own priorities, whether they be in health, education, infrastructure, etc., and not simply making up your own.

I wrote about donor distortions to Uganda’s health sector in this week’s Independent. I don’t think many U.S. taxpayers, for example, realise that they are contributing more to fighting HIV/AIDS in Uganda than the Ugandan government is contributing to Uganda’s health sector in its entirety. This is unacceptable on a number of levels. The current state of affairs is not the fault of only one party, but the donor/recipient relationship will never be equal and those involved should act/think accordingly, political correctness of “partnership” notwithstanding.

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Afrobarometer shows waning faith in NRM

Afrobarometer recently released the findings from it’s 2008 Round 4 Survey of Uganda. There were a number of interesting results. Among the most interesting to me were those on trust in government institutions, a major increase in support for presidential term limits since 2005, and the lack of NRM support in urban areas.

“Museveni not likely to win clear majority in 2011 elections” was the Daily Monitor’s headline for a special report on the poll.

Trust in government institutions fell since the 2005 Afrobarometer survey across the board — 20 percentage points or more for the president, the ruling party, the courts, the police and the electoral commission. Trust in the opposition party increased slightly, but was also was the least “trusted” to begin with.

Overall, it appears people are tiring of the incompetence and corruption of the ruling party, but the lack of support for the opposition suggests they do not yet see another good option outside of NRM. With less than 2 years until the 2011 elections, now is the time for the opposition to get serious about their campaign.

More analysis to come…

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Torture in Uganda


Torture has been a sensitive subject for the government of Uganda, and has led to the arrest of journalists who cover the topic. Human Rights Watch today released their 89-page report, “Open Secret: Illegal Detention and Torture by the Joint Anti-Terrorism Task Force in Uganda.”

An article highlighting information related to the killing of four suspects can be found here.

A summary of the report, published in the Daily Monitor, is below:

JATT is torturing suspects – report

The Human Rights Watch will today release a report in which the Joint Anti-Terrorism Task Force (JATT), an arm of the Chieftaincy of Military Intelligence, is expected to be accused of wide-scale use of torture and illegal detention of suspects. The report is expected to put the government’s rights record in the spotlight.

Conducted between August 2008 and February 2009, the report lies on testimonies from former detainees.
This won’t be the first time the rights body takes issue with the government on abuse of human rights and freedoms.

Past reports have accused the government of torture, questioned transparency of security agencies and general transgression on the rule of law.

The last human rights report condemned the 2006 election violence, intimidation of the Opposition and raised concerns of fairness ahead of the 2011 elections.

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When the beater is beaten, who wins?

This morning in Mulago hospital, a young man lay on a stretcher in the emergency ward, the side of his head split open over a lump that had swelled to the size of an apple. “Mob justice,” explained a nurse. “They were found beating a woman, and so they were beaten.” In the hall outside the room, two police officers waited for their suspects to be released. In the next room, patients waited to see the triage nurse, to register, to be whisked away to the appropriate ward, some of which remained too full to admit new patients.

I hoped the young man would make it, but I couldn’t help thinking that he was taking doctors and nurses away from so many other patients who hadn’t landed in the emergency room for beating someone (if in fact the story was correct, which it sometimes is not in the case of mob justice). I am sure the police saved the young man and his accomplice from the certain death they would have encountered at the hands of the mob.

According to Uganda’s 2008 Annual Crime Report, released last month, the incidence of mob justice is on the rise. The statement read by Inspector General of Police Maj. Gen. Kale Kayihura, “Last year registered a 100% increase in cases of mob action leading to death, from 184 cases in 2007, to 368 cases in 2008. Of these instances, 232 suspects were lynched on suspicion of theft and 59 on suspicion of murder. Suspected robbers, burglars and witchdoctors were other categories of persons murdered through mob action.”

He continued, “I am putting the public on notice that no one shall be allowed to take the law into their own hands, whatever the provocation or perceived justification. I have given strict instruction to the CID to apprehend and have all persons involved in mob action charged with murder.”

I am not sure what the apparent increase in prevalence of mob justice indicates. The obvious explanation for mob justice is that people feel that the legal justice system does not work for them and therefore must take matters into their own hands. But why more so now than before?

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Want a Condom? Think again in the land of ABC

Uganda has long been hailed for its success in fighting HIV/AIDS, bringing prevalence rates from a high of 20-30% (depending on estimates) to 6%, where it has remained for the past several years. The success was attributed, among other things, to the ABC campaign — abstinence, “be faithful” and condom use. Well, I’m not sure about either the abstinence or the being faithful bit (though a new effort is being pushed forward with the be red campaign), but condom use remains tricky around here.

New Vision ran a fascinating piece in their Sunday edition, sending out reporters around the city/country asking to buy a condom from various shops. Results were mixed, but in general most were ridiculed, laughed at, or looked down upon for their purchase, where they were able to make it. It seemed to me the women fared worse…The men’s accounts are here and here, the women’s here, here and here.

This combined with the not uncommon idea that using a condom during sex is like eating candy with the wrapper on…

In any case, for those who thought promoting condom use abroad would be as (relatively) easy as it has been in the U.S. (where you often have 12 year olds putting condoms on bananas during sex ed class) should seriously think again, even in countries that have been supposedly successful in the fight against HIV/AIDS….

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Rwanda Rwanda

I’ve just returned from a week in Kigali. Unfortunately my power adapter blew out the first night so I was basically computer/internet-less for the week (especially since internet at Bourbon Cafe is 4000 francs after the first hour!!! That’s about $7). All that means is that I have a lot to catch up on. The most exciting thing for me was to visit King Faisal Hospital, Rwanda’s main referral hospital. This place is seriously impressive. We spent about an hour with a Ugandan radiologist who had previously worked in both Mulago and Mbarara hospitals. Long story short, he became so frustrated with his inability to treat patients in Uganda that he took a chance on Rwanda. Since coming to King Faisal, he was able to acquire a new CT scan, a flouroscope, and a machine to do mammograms, among others. He is also excited about getting an MRI machine at the end of this year, which I believe will be the only MRI in Rwanda. There is also a digital x-ray so that films are no longer needed, and so that doctors and patients can share and consult on results much faster and easier.

The doctor (who prefers to remain anonymous) bustled about the radiology department, clearly proud of his work and the service he is able to provide to his patients. After a while though, he insisted he had to get back to work. “If a patient waits for more than 15 minutes,” he says, “you’ll have the ministry [of health] calling you the next day.”

Much more on Rwanda soon. An amazing country and government, despite the fact that some (ahem! France) have beef with Kagame.

In other news, but on a related health note, I went with David (see “What Would You Do?”) to the Surgery in Kampala today. At numerous clinics/hospitals, he has variously been diagnosed with: malaria, ulcers, cancer, and typhoid, to mention a few. So we went today to Dr. Stockley to get a second (ok, more like fifth) opinion. After 3 hours and $70 we walked away with a diagnosis and treatment. The culprit(s) for the pain and suffering he has been undergoing for the past few weeks/months? Bilharzia, amoebiasis, and internal yeast infection. No wonder he felt like crap. I couldn’t help but think he would have been treated much better and faster if he had been a Rwandan instead of Ugandan citizen…but we have hope for the future. And I am a patriot, Mr. President. Are you?

Tomorrow I am off to Mulago for a story for the Independent. You can be sure I will be ranting in 24 hrs time…

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$450 a month

That’s what senior doctors are paid by the government of Uganda at Mulago hospital, according to the latest article on Mulago in the Daily Monitor. New recruits make only Ushs 626,181 (about $315 dollars) a month, still better than the Ushs 200,000 a month new teachers are paid (about $100), but it is not hard to see why doctors who have invested much more time and money in their education would hop on the next flight out of Entebbe to more enticing salaries abroad.

By contrast, in Rwanda, newly recruited doctors reportedly earn $2000. What is going on here? Or maybe the better question is, what is going on in Rwanda? As it happens, I am headed to Kigali on the 9am bus today, and hopefully some answers will emerge this week for me…

In the meantime, see this interesting discussion (hat tip Paul Collier and Jim Cust’s Bottom Billion Blog) on Rwanda as “The World’s Social Innovation Capital”. More from Kigali soon….

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Christmas Came Early for Uganda Police

It seems Uganda’s Ministry of Works and Transport is tired of taking all the heat for the country’s shabby roads and high road accident rate. Daily Monitor writes today:

All motor vehicles in the country must be compulsorily tested for road worthiness, the Ministry of Works and Transport has revealed.

In a new law that seeks to reduce road carnage, the ministry has proposed strict electronic testing of private vehicles at least once every year while public vehicles will be scrutinised twice a year.

“The system we are using currently to inspect vehicles is inadequate and out of fashion but this new system will be like an x-ray, and no vehicle without an inspection certificate will be allowed on the road,” Works Minister John Nasasira said.

Um, excuse me? An x-ray? We don’t even have working x-rays in the hospitals! Ok, well at least they don’t all work all the time. In any case, I highly suspect that bad drivers and bad roads account for the majority of road traffic accidents/deaths, not the vehicles themselves. Oh, and seatbelts. This drives me nuts. Parents, BUCKLE YOUR CHILD’S SEATBELT. You are wearing your seatbelt, make your child do the same. There is no excuse for putting your safety above theirs. If they don’t like wearing them, tough! They are children. They are your responsibility.

But I digress. Back to the “x-ray” inspection….

The police should be overjoyed at this new initiative. Now, along with lack of third-party insurance, logbooks/paperwork or driver’s permit (among other offenses), the police have another way to get some “lunch.” Here is how it will go*:

Officer: [Steps into road blowing whistle and waving. Positions himself such that driver can only stop, unless he hits the officer and/or swerves wildly while simultaneously pretending not to see him]

Driver: Yes, good afternoon officer.

Officer: Good afternoon. Can I see your driver’s permit?

Driver: Sure, here.

Officer: And inspection certificate?

Driver: Well, you see officer, after waiting two hours to get my vehicle tested, the power went out and the vehicle x-ray machine stopped working. And when it came on again, inspectors had gone for lunch. So I wasn’t able to get the certificate.

Officer: Hmm. But now, eh, you must have that inspection certificate. I don’t know what we do… [pause] I don’t want to take you to the station. [pause] You will pay a big fine if we go to the station.

Driver: Yes officer.

Officer: So. What do we do? [pause, tries to ascertain if he must be more direct]. I don’t want to take you to the station. [pause] You could give me something for lunch…

Driver: [pulls out wallet, slips a 10k note on the seat].

Officer: Ok then. Nice day.

End scene.

I still fail to understand why one must go to the station for a simple offense. Just give us a ticket! As it is, there is no incentive for either the police officer or the driver to abide by the law — if you do, you will go the station, fill out paper work, and pay a huge fine. If you don’t, the driver can part with 20k instead of 150k, right then and there, and the poorly paid officer can get a little bonus. Of course, not all not all officers and drivers will take the moral low ground. But I have a sneaking suspicion the majority do (I even know of someone who had to go to the ATM with the officer because he didn’t have the amount required for “lunch”!!!). And why not, when those poor officers get paid pennies (ok, shillings) to stand in the scorching sun for hours at a time? Oh, and Nasasira, please stop deflecting blame and do your job. I don’t care about decentralisation or KCC. You are the minister and you are responsible.

* As to whether I have ever encountered a similar situation, I will take the fifth.