Not in Kansas anymore

Sometimes I almost forget that I’m not in the U.S..  I’m starting to feel really comfortable here, and maybe I’m kind of getting sensitized to a different way of life.  In general, things aren’t as nice/fancy here as they are at home, but they serve their purpose.  I stop being surprised when I see dilapidated buildings and when I hear people shouting, “Mzungu, I love you!” at me.  I’m getting good at crossing the street and weaving in and out of taxis that are stuck in “the jam,” and I’m starting to know my way around the city.  Sometimes it starts to feel like home.

But then there is always an immediate reality check.  Today was like that.  We have now split up into electives for our classes, and my elective is Public Health.  We went to visit a health clinic in a village on the outskirts of the city.  We conducted focus group discussions about family planning with some people from the community, and we got a tour of the facilities.  The FGD went really well—we split into two groups, each talking to one gender group.  My group talked to the men, and it was actually a lot of fun.  They really loosened up and started joking with us, and it became a dialogue about culture and gender roles.  I’m going to write a whole blog about gender issues later, so I won’t go into that right now, but it was a really interesting/fun experience.

The mood got more sober really quickly, though, when we started getting a tour of the clinic.  The healthcare system in Uganda is supposed to be universal; people can go to any government health center and receive care free of charge.  There are 5 levels of health center, with the lower levels treating very few conditions and the higher levels treating everything.  This was a level 4 health center, which is supposed to be able to do everything except complex surgeries.  The grounds were extensive and in decent condition, but it became clear very quickly that there were major problems with the clinic.  They were drastically understaffed and didn’t have the most basic supplies/drugs.  There were around 35 patients waiting in the hallway to see one clinic officer, who I think is basically the equivalent of a Physician’s Assistant in the U.S. (and this was around 2pm in the afternoon).  In the maternity ward, the facilities for delivering a baby were really sparse.  There were two delivery tables, and that was pretty much all.  They didn’t have any blankets to wrap the babies in (the mothers have to bring those, along with sheets for their hospital bed when they come to deliver), no oxygen to jumpstart a baby’s breathing, not even anything to suction the nose/mouth (the first thing you’re supposed to do when delivering a baby).  And painkillers for the mom?  Forget it.

So basically, if the delivery is abnormal in any way, they are not equipped to deal with it.  They have a surgery wing, but they don’t have a surgeon; they have a blood bank but no blood.  They can supposedly refer to the main hospital if they are unable to handle a patient, but it takes so long to get between the two places (due to the roads and the traffic) that it seems unlikely to me that a patient with a severe health emergency would survive.  The only time-effective way to get between the two places would be to take a motorcycle taxi, called a boda boda.  I forgot to include those in my post about transportation, but they’re not that complicated.  Basically, some men have motorcycles that they drive around the city, and you can pay to get a ride almost anywhere on one.  They’re more expensive than regular taxis (from what I’ve heard it’s usually between 5000 and 6000 shillings to go across town, when it’s never more than 2000 on a conventional taxi), but they are a lot more maneuverable than the taxis, meaning you arrive much more quickly when you travel by boda.  We are forbidden to use them while we’re on the program because they are deemed unsafe.  I think this is a legitimate stipulation, because the boda bodas weave through traffic, sometimes driving on the wrong side of the road or the sidewalk to get around traffic jams, and the passengers never wear helmets.  (Surprisingly, the government just passed a law saying that all boda boda drivers have to wear helmets, and they are actually wearing them.  I say I’m surprised because laws really seem to have little legitimacy here…).  But back to the original point, a lot of the people we talked to at the clinic said it was already a struggle for them to pay enough to get there, so they certainly wouldn’t have enough to pay for more transport.

Also, there is the fact that they are unsafe.  While we were at the clinic, there was a car accident on the road right outside where a boda boda crashed into a taxi.  At first I thought it wasn’t a big deal since we were right outside of a clinic, and because people didn’t seem to be too worried about it.  But then as they were talking about it more, people were saying that the passenger who was on the boda was probably going to die.  That hit me pretty hard—she was a young woman, probably about my age, hadn’t been wearing a helmet, and sustained a pretty serious head injury.  Since I have training as an EMT, I was thinking about all the things that should be done for someone with a head injury, but then I realized that they had none of the resources to do any of those things.  It just made me so mad—I was thinking “What do you mean she’s going to DIE?!”  It’s just absurd that this happened right outside of a “high level” health center, and they couldn’t do anything for her.  They couldn’t even treat the driver, who was injured less severely.  They had to send them both to the main hospital (which we visited a few weeks ago, and it’s really not that much better equipped).

The whole trip just brought me sharply back to the reality of the situation, which is that I am in a resource-limited country, and when something goes wrong here, people usually aren’t able to deal with it.  It would probably be different if something like that happened to me, because I would be able to pay to go to a private clinic that would be better equipped.  But for the majority of the population, that’s not an option, and that is a sobering fact to remember.  For all the bad things people say about the U.S. (myself included), at least you know that if someone is having a health emergency, they will be taken to the hospital which will treat them to the best of their ability.  Like I said, this is just one of those sharp reminders that this setting is quite different.

This weekend we are leaving for a week-long trip to rural parts of Eastern Uganda, where I’m sure I’ll experience a lot of other things that are really different and difficult to comprehend.  So I’ll definitely come back with at least one blog entry, but I may not post for awhile because we won’t have internet access.  So until then, don’t worry about me, and take care everybody.  Peace.