DIAGNOSING REMOTENESS AS A DISEASE IN THE 21st CENTURY.
Margaret, a mother of two, is a resident of one of the remotest villages in Eastern Uganda. Her home is 20 KMs of straight line distance, 40 KMs of pothole road distance but 2 driving hours away from the nearest hospital that would provide maternity services. Her husband, who works in a sugar factory, commutes once a month to spend time with his family. The morning of 9th June 2014 began the day Margaret, who was fully nine months pregnant, got response to the questio
Author; Onesmus Kansiime 2022
n, “When was the worst day of your life?” I want us to imagine the excruciating labor pains that saw her through the 30 minutes’ struggle of contacting the nearest hospital for an ambulance, plus two hours of an ambulance reaching her home and another two hours of being transported to the hospital. Margaret gave birth to a “tired” baby girl as opposed to a bouncing one. Very exhausted, the baby was baptized immediately amidst a genuine pessimism that she wouldn’t see the ninth hour. We believe that Anna Mary, as was baptized, is in heaven. I know for sure that Anna Mary died of remoteness. We thank God that Margaret’s two children are not orphaned and her husband is not widowed.
Something could have been done before 9th June 2014 to include establishing a health center at Margaret’s parish that is 1 KM away from her home and/or constructing a better road to that far away hospital. Anna Mary could be in P.1 waiting from home with her siblings for the reopening of schools.
“The good thing with these vehicles and motorcycles is that they access impassable roads in the remote areas without health centers.” I thought. I worked my brain through it again, “Can’t these roads be made passable and hospitals built in those areas so that motorcycles and vehicles are used as ambulances in the presence of built hospitals within 2-5 KMs of good road distance?”
“I think we should not stop at extending mobile health services to remote areas and still leave these areas remote. We should make these areas accessible and establish health centers there.” I responded to a friend curious to know what I was thinking about. “That makes sense,” she said.
As of September 2020, the Electoral Commission reported that we had 10,595 parishes. If we prioritize the health sector for only 5 consecutive financial years to allocate it 15% of the budget as recommended by the 2001 Abuja Declaration, we can construct 10,595 health facilities (clinics, hospitals, Health Centers I, II, III) one in every parish. This will increase the number of health facilities in the country from 6,937 that include the private (For Profit and Not for Profit) and community hospitals to at least 17,000 health facilities countrywide that will be serving the 57 million Ugandans projected in 2025 and 3,353 beneficiaries for each health facility. The projection of 17,000 health facilities excludes the private facilities that will be established over the same period of time.
We can plan to have enough health personnel for these health facilities and here is how: As of 2015, according to a case study of General Practitioners in Uganda by the Ministry of Health and the African Centre for Global Health and Social Transformation, Uganda had 4,811 medical doctors that comprised only 6% of the entire health workforce. 3,993, 83% of them, were general practitioners. As of 2020, the Uganda Medical Association was a family of 6,000 doctors that shows a growth rate of 19.8% over the Past 5 years.
Efforts such as subsiding the medical education, admitting more students on Government scholarship for medical courses and encouraging at least 15% of the 70,167 registered nurses to upgrade to medical doctors every year could be undertaken. With these efforts, we could see a 100% and 900% growth rate in the medical family to have at least 12,000 and 60,000 medical doctors by 2025 and 2030 respectively. Taking the same principle, we could have the same growth rate for the nurses to have at least 150,000 registered nurses by 2025 and 700,000 by 2030 to serve the projected 57m and 80m people population respectively. That means that by 2030, there will be one nurse for every 115 people and one medical doctor for every 1,334 compared to the 1:671 and 1:7833 ratios of 2020 respectively. Better pay can be ensured to retain the expertise lost to brain drain. A better transport and communication system must also be put in place to ensure access to the established health facilities.
The presence of these, to include better accessibility, will inspire the private sector to set up both for Profit and Not for Profit health facilities in these remote areas.
It is true we have come from far: According to UNICEF 2019, since 2000, child deaths have reduced by a half and maternal deaths have reduced by one third. Lack of access to quick life saving health services especially in nearby hospitals is responsible for more than 60% of these deaths to include 96 daily still births, 81 babies of less than a month old that die daily and the one in 49 women that dies of a maternal complication related to pregnancy or delivery and others dying of preventable causes such as diarrhea and skin diseases. I am hopeful we can do better.
The struggle of access to quick lifesaving health services dates back to the human era of carrying patients on our backs to either herbalists or traditional shrines to using stretchers since c.1380 and domesticated camels since 980 BC. Today, we are using motorcycles to reach inaccessible areas to deliver medication. It is okay to do the best we can in the worst case scenario but one wonders why these areas are still inaccessible and without health facilities. Remember, these movements are not only made to provide medication to non-urgent health conditions such as impotence and infertility but also to emergencies such as childbirth and snake bites.
I acknowledge the need for mobile health services in the fourth industrial revolution but they can co-exist with brick and mortar establishments, stocked with drugs, with more medical personnel, better transport and communication systems in the remote areas to “de-remotise” them.
There has been a culture of disease exportation to other countries for treatment but I think it is more miserable to see people moving from one region of a small nation to another to seek better care and treatment.
By Kansiime Onesmus 2022
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