Ssese beauty blighted by dysfunctional health system

Don’t let the tranquil, picturesque seclusion of the island district of Kalangala fool you; this home to Ssese islands, an archipelago of 84 islands, is a perfect natural beauty, but also a poster child for numerous health and system plagues associated with many far-flung districts. Seeing Lake Victoria’s waves reluctantly touch the shores and feeling the morning chill bite one’s skin is tantalizing. However, on this particular morning, hundreds of people saunter through the serpentine roads on Bugala Island to receive free medical care courtesy of a medical camp organised by Uganda Health Marketing Group (UHMG) last week. The stories from the locals about the challenges of accessing health services are striking. Robina Nakato, formerly from the island of Bubeke whose toddler died earlier this year from severe malaria, blames the death on the poor quality health care on the island. “I had earlier reported to a drug store in Bubeke and was given drugs by a ‘nurse’ since there was no doctor, but [the drugs] did not work. I cannot afford coming to Kalangala Health Centre IV all the time, because a trip costs me about Shs 40,000, which I don’t have,” the mother of two says. “My son worsened at home and a few hours after arriving at the health centre, he died.” ACCESS DELAYS There is no district hospital and Kalangala HC IV is the main referral health facility for the 64 habitable islands. The islanders have repeatedly highlighted the austerity of an inadequate transportation to access health facilities, leaving many of them to resort to the expensive and scarce private clinics or even traditional healers. “That night will forever haunt us, because I wonder, had it not been for the transport delay and earlier wrong diagnosis, would my son be alive?” Nakato forlornly says. According to Willy Lugoloobi, the Kalangala district chairman, Bubeke and Mazinga islands are the hardest to reach. It will cost a person 80 litres of fuel and four litres of oil to travel from Bubeke to Kalangala HCIV. For those from Mazinga Island, the furthest from Kalangala town council, it takes 100 litres of fuel and five litres of oil. Each litre of fuel costs Shs 5000 in these parts. “In Kalangala, a walkable distance is talked of in terms of a swimmable distance. It is not only a hard-to-reach district but also a hard-to-stay in. About Shs 600,000 for primary health care is channelled in per quarter but even accessing that money from the bank is hard. In Mazinga, you have to use eight litres of fuel to reach the bank,” Lugoloobi says. All the islands are served by only 15 health centres, two thirds of which are located on Bugala, Kalangala district’s biggest and administrative island. Further referrals to Entebbe hospital or Masaka regional referral hospital are facilitated by the MV Kalangala ferry that costs Shs 15,000 per head from Lutoboka to Nakiwogo in Entebbe, and MV Pearl that docks at Bukakata, respectively. Deeply concerned for the wellbeing of their other children, Nakato and her family moved to Bugala last year. Unlike Nakato who could afford moving nearer to the health facility, thousands remain stranded on smaller islands meaning that delays in accessing health care services is costing lives and hampering the right to health. According to the 1995 Uganda Constitution, Objective XIV (b), the state shall ensure that all Ugandans enjoy the rights, opportunities and access to health services. However, the realisation of this access is still a far cry for the locals in Kalangala. According to the district’s statistics, only 17 per cent of expectant women deliver in health facilities. Sarah Subo, a health educator with the district for 15 years, says majority of the women depend on traditional birth attendants. MORE DEPRESSION Although health worker deployment is at 80 per cent within the district, Lugoloobi says that harsh working conditions are forcing medical workers out. “Teachers are now forced to share their accommodation with medical workers, because medics have nowhere to sleep,” he agonised. Moreover, HIV prevalence remains high at 25 percent which implies that 25 of every 100 people are infected. Subo attributes the high prevalence to the falling condom use in the face of ever increasing commercial sex associated with fishing communities. “Unprotected sex costs Shs 20,000 and above, whereas protected sex is negotiable from about Shs 5000. Having more than eight sexual partners and swapping them is also common,” Subo explains, adding that the vice is spreading to adolescents too. The high prevalence is also brought on by drug stock outs in some months. To deal with these challenges, Prof George Kirya, a founder member of UHMG says it (UHMG) organises annual health camps in the district, bringing drugs, HIV testing, cancer screening, immunisation and health awareness closer to the locals. However, Lugoloobi says, all the health problems cannot be met in a health camp. “We need a district hospital and more health centres, because each of the seven sub counties is supposed to have a Health centre III. We appreciate the camp efforts but if one gets sick after, they are met with the familiar challenges,” he said. NEW PLEDGES Sarah Opendi, the state minister of health in charge of primary health care pledged to give the district two motorised boats to ease health workers’ movement among the islands. Their delivery is expected in August this year. “Government is also going to give the district priority status and establish maternity wards to reduce on maternal deaths,” she told residents during the health camp. Opendi, however, urged them to observe personal hygiene and safe practices to avoid diseases such as cholera. At least 1000 women, men and children attended the camp.