Week 6: There Is No Need to Break a Glass Window with a Stone

Location: Ssese Islands, Kalangala District, Uganda

This whole trip thus far in Uganda has been very eye-opening for me. Not only did I get a chance to see the healthcare of a developing country in motion, but I think it has given me a chance to realize the specific goals I had in life. From our public health classes, and our trips to Masaka, Ssese Islands, Rakai, etc. we have learned about the structure and hierarchy of Uganda’s healthcare system and how referral systems operate.

At the highest level, there are the national and referral hospitals. These are the biggest and most well-equipped hospitals in the country that takes referral patients and patients with more serious conditions. This is followed by the district hospitals, such as Mulago Hospital. The conditions of these hospitals may not be great, and they are severely understaffed per patient basis, but they do have the faculty and doctors who are knowledgeable and educated in practice. Following the hospitals are health centers IV, III, II, and I, respectively located in the county, sub-county, parish, and village. Health centers IV should have a presence of a doctor and an operational theater increasing equity and access especially for emergency obstretic care. According to law, there should be a HC IV in all divisions or counties. Further decentralization from HC III – I serve subcounties, parishes, and villages. These may not necessarily contain a doctor, but need to be staffed with well-trained enough to test for HIV/AIDS, provide counseling to patients that need it, and have the knowledge to deliver treatment for the characteristic diseases.

The structure of this health system is strong and foundational, providing decentralization of power and a higher integration of rural villages into the healthcare system. However, the problem is actually staffing and providing all these health care centers to the people. Ssese Islands is an archipelago of 84 islands, I think 72 of which are inhabited. The inhabited islands are separated into two districts and counties. You would think that with over 34 thousand inhabitants, they would have hospitals available to the people of the Kalangala district. Keeping the knowledge of the health delivery system in the back of your head, gather this: The whole district of Kalangala has one HC IV, six HC IIIs, four HC IIs, and no hospital. The HC IV (which should always be staffed with doctors and operational theaters), do have a maternity and general ward, but have no functional theatres at the HC IVs and most health centres do not have adequate space, equipment and staff for the effective delivery of health service. Five parishes don’t even have any form of health centers whatsoever. And finally, there is only ONE doctor in the whole Kalangala district, and he doesn’t even live there. He goes back to Kampala on weekends. The quality of healthcare is so low there is still no clear assessment as to how prevalent HIV/AIDS is in that region.

Needless to say, the healthcare system, though improving, is very far behind. Joel has showered us with those facts and has provided us with the capacity to realize how far behind the rural part of Kampala really is in terms of healthcare. Living in Kampala most of the time, we don’t really get a chance to see how the majority of Ugandans live. Activities such as these and our MDD performance in Busabi put everything in perspective, giving us a better understanding of the challenges a third world country faces. Now, I can only hope that we can make a difference.

Much of the data was gathered through Joel's brain, our great Public Health classes, and this link: http://www.ugandatravelguide.com/kalangala-sseseisland.html