Seliviya Nyilabavakule. She is a 30-year-old farmer, mother of five children, who has the condition known as fistula and has been waiting for surgery for the past two months. She suffered fistula as a result of an injury in childbirth this year, when her baby died in childbirth. She had to borrow money for the fistula surgery and could not plant her crops this year, so she's worried that she won't be able to provide food for her children.Edward Echwalu for The Globe and Mail
The ambulance at Kawempe Health Centre consists of a pick-up truck with a mattress slung in the back. A midwife crouches in the back of the truck to hold the intravenous drip, sometimes in the pouring rain, when pregnant women are rushed to hospital with complications.
Because of chronic supply shortages, patients are routinely ordered to buy their own sutures, gloves and cotton wool. When they can't afford sutures, they improvise by buying ordinary thread, even though it can't hold the skin together.
With 10,000 outpatients and 600 babies delivered every month, Kawempe Health Centre is typical of Uganda's overcrowded and underfunded clinics. Often two or three women must share the same bed. When their babies are born, the new mothers are hastily evicted within a few hours, so that others can be admitted.
"They are too much for our infrastructure," sighs Irene Nabukwasi, the head nurse. "We're working under very difficult conditions, but we're doing our best."
The clinic has only one-fifth of the number of nurses that it needs, she says. It has no sterilizing equipment, so it has to constantly buy new razor blades for one-time use. It lacks any oxygen to revive weakened patients. It has no operating theatre, so pregnant women must be rushed to a bigger hospital for any complication or even a Caesarean section.
Clinics such as Kawempe are quick to send their female patients to bigger hospitals because it absolves them of responsibility for complications or difficult deliveries, analysts say. But women are often reluctant to go. They can't afford the transport costs or the inevitable demands for payment for medicine and basic supplies – even though their health care is supposed to be free.
If they proceed, they end up at places like Mulago Hospital, the biggest hospital in Uganda, which is plagued by overcrowding and shortages. Ward 11, the post-natal ward at Mulago, is so shabby that its windows are broken, and so crowded that women and babies are left on mats on corridor floors and on the concrete entranceway outside. Some must sleep on the floor beneath the beds of others. Many of its patients have been waiting weeks for essential surgery.
Siliviya Nyilabawakule, a 30-year-old farmer and mother of five children, has been waiting two months for surgery for fistula – a painful condition that leaves her incontinent. She suffered the condition after her sixth and seventh babies died in childbirth. People avoid her because she can't control her urine, so she stays at home, embarrassed, isolated from everyone.
When she heard that Mulago Hospital was offering free surgery for fistula patients, she and her husband made the long journey to Kampala. They had to borrow 80,000 shillings (about $30) from private lenders to pay for their transportation and living expenses – and they had to use a quarter of their two-acre farm plot as collateral for their loan.
When they arrived, she had to wait day after day for the surgery, not knowing when it would take place, worrying about their children back home and wondering whether they'd need to borrow more money.
Because of their new debt, they could not plant a crop this year, cutting back on their food for the year. "I keep thinking how I'll find the money for my children's expenses," Ms. Nyilabawakule said. "The season for planting is over. I worry about what we will eat, about how my children will manage to go to school."
Geoffrey York