Kaladima Health Center is a level III health center: intended to serve a population of 20,000 people with about 18 staff members. There are two buildings for patients: the outpatient clinic, largely handled by the senior clinical officer, and the maternity ward. The only way the center does not crumple catering to 20,000 patients is that most of them cannot access it: the barriers of geography, transportation, and a lack of health education are often insurmountable.
On the first morning we arrived at Kaladima to pick up staff for counseling and testing outreach, there was one midwife on duty in the ward. She had been awake for almost 48 hours, and had delivered six children since the evening before. The other midwife was away from the health center, and the woman on duty told us that because of the workload, she’d been unable to take a break to eat in twelve hours.
Achoko Franny, the coordinator of GlobeMed’s project with GWED-G and former practicing midwife, led us into one of the two rooms of the ward, where five women, their newborns, and some family members sat together.
While most of the women, tired but happy, engaged immediately with Franny as she complimented their babies, one young woman lying on a bare mattress seemed half-conscious.
Grace (name changed for privacy) had come with her husband from Guru Guru the night before to deliver her child, her third at the age of 23. After giving birth that morning, she had experienced a severe postpartum hemorrhage: since health center IIIs are not equipped to perform blood transfusions, the sleep-deprived midwife had done her best to revive the young mother the three times she went into shock and lost consciousness, but could only hope to slow the bleeding. Grace’s husband had left after being informed of the hemorrhage.
By the time the GROW team arrived in the maternity ward, the midwife had told Grace’s in-laws that she had to be taken to Lachor Hospital, a private facility, for a blood transfusion—lacking any transport, they were planning on hiring a boda-boda (motorcycle taxi) to take her. Riding on the back of a motorcycle immediately following birth and hemorrhage was the only way to get her to a health facility with the capacity to save her life.
Fortunately, we had just arrived in a GWED-G car, and went to go ask our driver Isaac if he could take Grace and another woman in labor to Lachor, while Franny gave the midwife some money for a meal. Being an absolutely fantastic man, our driver agreed, and told us to find a health worker who could go with them to the hospital to make the referral in person.
We came back to the maternity ward to see Grace and her in-laws packing up to walk home. Confused, we asked Franny to inform them that we had found free transportation to take Grace to the hospital.
“Lachor is a private hospital. It’s low-cost but she does not have even a single shilling,” she explained.
Blood transfusions and an overnight stay, the minimum health care Grace required, would cost 50,000 shillings—just over $15. But the average monthly income of a rural household in Northern Uganda is around 76,200 shillings, and she had nothing.
She had walked, possibly in labor, from Guru Guru to the health center. Guru Guru is what is known by GWED-G and the Ugandan government as a “hard-to-reach” community: a long way from anything else on terrible roads. The government had to promise health workers assigned to Guru Guru extra pay, since they have to visit the communities they serve so often—and when the government never followed through on that compensation, most health workers assigned there relocated immediately.
She had made it to Kaladima Health Center, where there was a maternity ward with a delivery room that, after last year’s GROW team donated a curtain, has a partition for privacy. She had delivered her newborn child, and when she began to bleed uncontrollably, had been kept alive by a sleep-deprived, hungry, and tremendously dedicated midwife despite being in a facility unequipped to handle those emergencies.
She had been willing to brave a motorcycle ride, while fading in and out of consciousness, to travel even further to a hospital that could save her life. But lacking the funds, her in-laws were ushering her to walk home, probably to die.
The GROW team found the whole situation pretty horrifying, and gave her the 50,000 shillings to cover her bill from Lachor, and made sure she got into the GWED-G car with the senior clinical officer and the other woman in labor who the midwife was too exhausted to help.
But Uganda has one of the highest birth rates in the world, at 5.96 children born per woman, and you can bet a group of muzungus aren’t going to show up to each of those births with a car and stack of shillings. The gaps in transportation and income are life-threatening for Ugandans, especially rural women like Grace.
One way GWED-G and GlobeMed hope to mitigate these situations is by raising the money for a GWED-G van, to be used as an ambulance for HIV+ women going into labor. We want to increase access to necessary health care for the people who cannot reach it, and start to bridge the gaps that might have led to a woman dying on the back of a boda-boda, or on her walk home.