I remember the moment when I knew that I needed to stay in Uganda for another year.
Let me start from the beginning: I serve as a GHC fellow at Clinton Health Access Initiative in Uganda. I am privileged to wake up every morning excited to go to work. Through my work, I have had the opportunity to spend time in health clinics throughout all regions of Uganda. Last month, we traveled to a small health center in rural Buyende District. Everything about it was routine, but when we arrived, it was clear that this visit would be different.
Forty-eight hours before we arrived, the maternity ward caught fire and had since been reduced to a pile of black metal and ash. It is difficult to put into words what we saw that day: a charred skeleton of a building; every window an empty hole; glass spread into a layer of glistening shards. The beds that used to hold mothers were twisted and lying in crumpled piles. A clear and beautiful blue sky towered above, where the roof used to be. In Uganda, there are no computers that store patient clinical history and contact information. All records are paper based. In the fire, the head midwife told us, every single patient file – including details about when mothers had started HIV treatment, what regimens had or had not worked – had been destroyed. As the head midwife spoke to us, she was in the same blue dress that she wore on the night of the fire. She had no other clothes to wear, as all of her possessions were destroyed in the fire.
We walked over to an administrative office, where pregnant mothers were now being diverted. Every inch of the office floor was occupied by a mother waiting to be seen. One woman was being examined by a nurse in the middle of the room – stretched out on an office table that still had pens and paper in a corner. That morning, a nurse told us, one of the mothers had begun labor: the moaning we could hear coming from the bathroom, adjacent to the room we were standing in, was the only area of privacy that could be offered to her.
Five years. That was the answer that I received when I asked the head midwife how long it would take to rebuild the maternity ward. I must have looked as shocked as I felt, because the midwife explained it would require five years to get funding streams and government contractors organized, and because five years is how long it took to get this ward built the first time. I felt like the women sitting in that office – the one laboring in the bathroom – could not wait five days for a new ward, let alone years. “Will the mothers continue to be seen in that office?” I asked, already knowing the answer.
Growing up in the United States, I was surrounded by mantras that propagate narratives with happy endings. “We are never tested by something that we cannot overcome.” “If it is not okay, it is not the end.” Standing in the administrative office in Buyende District, I was touched by the ability of patients and nurses to “make it work” in what appeared to me as unbearable circumstances, but it did not feel right. The strength of the human spirit is strong, but this was blatant inequality. No human spirit should have to encounter this much stress, frustration, or exhaustion in providing basic health services to mothers.
I am staying in Uganda for another year. I cannot wait to get to work.