Mitandi is one of the areas that in our government policy we always call hard to reach areas. It took us wrong turns before we got our way around to the Mitandi health center in Mitandi sub-county Kabarole off Fort Portal – Kasese road.
I was with the US Mission in Uganda on a visit to US government-supported projects on maternal health and family planning. This trip was organized for Lois Quam, the Executive Director of President Obama’s Global Health Initiative (GHI). The visit to Mitandi was one to find out how the projects are fairing and the progress of Uganda government efforts to reduce maternal deaths by 50 percent in four western Uganda districts by end of 2012.
Uganda has one of the highest maternal mortality rates in the world at 435 per 100,000 live births. Mitandi is one of the difficult places to reach in Uganda where health services and indicators are always way below the national average. We found our way up the mountains to where the health centre sits atop a hill next to secondary school in the Rwenzori ranges.
Mitandi is a not-for-profit health center III run by the Seventh Adventist Church. The Health Center serves an area of about 40,000 people and it is the major health facility in the whole sub county. The nearest bigger health center is Kibiito health center IV about 20 km away.
Before 2010, Mitandi delivered less than five mothers per month; two years down the road the center delivers more than 20. This magic increase in number of women delivering at a health center that is even still understaffed is connected to a voucher system which has been getting funds from the US government.
On Wednesday March 30, I visited Buyinja Health Center IV in the newly created district of Namayingo which lies on the shores of Lake Victoria in eastern Uganda (somehow we rarely say south east). I was there to interview Jessica Were, a woman nominated for the upcoming Women of Courage Awards hosted by Isis-WICCE and the US Embassy in Kampala. Were is a mother mentor working to bring mothers to get more involved in Prevention of Mother to Child Transmission (PMCT) of HIV. She also works to defend the rights of women living with HIV and orphans who are always denied land.
In a new district, Buyinja is supposed to be elevated to a hospital but for now it has a few blocks with a male and female wards and a maternity wing. Jenifer Friday arrived on a boda boda (‘motorcycle taxi’). When I saw her I thought she had come for checkup but she didn’t go to the separate block where Were educates these women. Fifteen minutes later I enter the maternity ward to catch a few shots to show Were’s working environment. I find Jenifer with a child who is barely two years crying out loud. Jenifer was also shouting as her labour pains increased.
Jenifer arrived at this health center with nothing but her child on way to deliver another child. She had no clothes, no relative accompanying her. In fact her husband sent her to mother’s place at eight months. Nurses looked around for any cloth; they work with barely anything. Sometimes they have to give their own clothes to cover babies and mothers like Jenifer. The nurse in charge tells me that there are many like Jenifer who arrive at the center with nothing. Health centers rarely has gloves, razors and cloth, most stuff essential during delivery. I wondered how health workers keep their balance in such conditions.
Jenifer is 19 years old and she was having her second child. She delivered her first child at a traditional birth attendant’s place and after hearing Were’s message she made it here. Were had to call relatives and they appeared after about an hour with a few clothes. Were had to tell that Jennifer needed sanitary towels or cotton and underwear.
Jenifer’s first child is from another man so she is basically lucky that her current husband would marry her and take care of both. In that position Jenifer couldn’t bargain to wait for the old child to grow before having this man’s child. She does home cores and the husband cleans boda boda for a living. I asked her what she would want to do in her life if given an opportunity; she was quiet for a while. Later she told me she wants to be a tailor.
Jenifer was about 17 when she got her first child and at the time she was in primary seven. Talking to her minutes after she delivered a baby girl called Scovia, I reflected on what difference education could have brought to Jenifer’s life. At 18 I was headed to university. For girls like Jenifer, their education is interrupted by so many things including poverty and general attitudes towards educating a girl child. By the time she’s 18 and in primary school, the chances of pregnancy and dropping out of school are high.