Disaster on Kaabong Highway, Part 4: Africa’s Health Care Systems Strike Back

Police officer inspecting the damage while the crowd looks on

Police officer inspecting the damage while the crowd looks on

For part 3, click here

To start from the beginning, click here

The police had called a tow truck, but when it arrived it became immediately apparent that it could not tow the van.  The “tow truck” was nothing more than a beat up old Land Rover that looked as if it had been disassembled and reassembled several times, driven by two yellow-eyed Karamojong men with a bit too much money and a bit too few teeth.  The Land Rover probably could have towed a normal car, but the Super Custom’s front wheels could no longer turn, as the front axle had been mangled such that the wheels now bent 45-degrees inwards.  The police had to look for a bigger truck that could get the van’s front wheels off the ground.  And Jolly was still in the hospital receiving God knows what kind of medical attention.

David was here now though, and he offered to escort the van to the police station, freeing me to check on Jolly.  The Land Rover guys also made themselves useful by giving me a lift to the hospital for UGX 20,000, which was an experience in itself.  Their eyes were bloodshot, and the driver cackled rather than laughed, the corners of his mouth turned up in a manic expression that bared all his missing teeth.

At least the Land Rover had a seat belt.  My exhortations to drive slowly even met rare success, the driver having seen the carnage of the Super Custom.  They dropped me at the hospital and I rushed in.

Kaabong Hospital is a surprisingly impressive facility on the surface.  Covered walkways criss-cross green courtyards to connect a half dozen solidly-constructed buildings, the roofs of which are adorned by at least $100,000 worth of solar installations: several kilowatts of solar panels, Solahart solar water heaters, all professionally and expensively installed, no doubt funded by some well-intentioned international organization.

But all those good intentions have not translated into a sustainable health care system.  The solar system hardly works anymore.  At night the lights in most of the walkways are off, leaving the courtyard pitch black on a moonless night.  Maintaining things is just not how it’s done in Africa, especially if the things being maintained were given freely by expats who donate and disappear!

The actual health care infrastructure is even more woeful.  I saw only one doctor the whole time I was there, and this at a hospital that serves a district of nearly 400,000 people.  The staff seemed hardly motivated; no doubt it’s hard to stay driven when you perpetually lack resources to save patients.  Hospital rooms are so ill equipped that it’s hard to distinguish them as medical facilities at all.  There is no CT scanner, of course, but even the simplest medicines are in short supply because the government sends physical medicine instead of cash: when medicine runs out, the hospital cannot buy more, but has to wait for more to be sent from Kampala.  Hence at one point I had to give a nurse UGX 5,000 ($2) to buy a glucose solution from the local private health center.  He was not allowed to use hospital money.

(Meanwhile the brand new hotel I was staying in, with stainless steel showers, excellent water pressure, a comfortable bed, and a solar system that DID work, is owned by the District Health Officer.  Construction is underway on a second floor.  I spotted his deputy driving around in a brand new $60,000 Land Cruiser, its red license plate indicating that it had been imported duty free.  See a connection?)

It was inside one of these bleak hospital rooms that Jolly was being seen by the medical staff, lying on an old hospital bed that was about the only medical-ish piece of equipment in the room.  His eyes were open but unseeing, rolling from side to side aimlessly, his arms flailing pointlessly; he was awake but not connected to the world, his movements not directed by any conscious part of his brain.  The only good sign was that he WAS moving: at least he had not been paralyzed.

As ill-equipped as the hospital staff were, at least they DID have enough experience treating road accidents to know exactly what to do with Jolly—the positive side of Uganda’s dangerous roads I suppose.  They gave him medicine to reduce brain swelling (generally considered the most dangerous complication of head trauma), and advised me that he would need to stay there overnight until his condition was stable enough to transport him to a better hospital; the nearest one with a CT scanner would be an 8 hour drive.

At this point the doctor was heading home, and I got a good look at the night-shift nurse into whose care we would be entrusting Jolly’s life for the next 12 hours.  Squinting yellow eyes betraying no spark of intelligence or purpose peered out aimlessly from his oily and unwashed face, his head hunched forward and his movements lurching like a mentally ill street drunk.  His breath smelled suspiciously of alcohol, and he would disappear periodically into a closet-like room only to emerge looking even more like he had just woken up than before.

Clearly I was going to be spending the night at the hospital.  The other patients’ caretakers had similar ideas, and were preparing to camp out for the night.  Jolly had been moved onto a mattress on the floor in a larger room with four other beds divided by a short partition, each quadrant containing a patient in varying states of illness—and for each patient there was at least one family member or friend staying at the bedside.

When the hospital doesn’t have machines or people to monitor its patients’ conditions, family members must take on that job.

But before the ordeal must come food, so before the night nurse’s condition deteriorated any further, I went out to see if there were any carbohydrates or amino acids left in town.  It was 8pm, so the prospects of any restaurant having food were dubious.  And indeed, the restaurant that had successfully provided pilau the night before (rice cooked with MSG and beef) had only chapatti and mandazi left, so I satiated my stomach with a medley of white flour and oil.

After finishing dinner, David and I agreed that I would take the first shift, and he would take over from me at 3am.  He dropped me off at the hospital at around 9:30, and I navigated from the parking lot to the hospital room through the maze of black corridors, lit only by the innumerable stars.

The night-shift nurse’s whereabouts were traceable only by the sounds of snores coming from his closet-room.  In the patient area there was almost no sound to break the heavy air: only an occasional grunt, the metallic squeaking of springs from a patient shifting in his bed, or the whispers of some family member talking softly or comforting a patient.  And of course the buzzing of mosquitoes.

The mosquitoes were intolerable, and I wondered if my vigil would be rewarded with a dose of malaria.  I yearned for my electric mosquito racquet, but it was sitting useless in Kampala.  Every few seconds one of the irritating insects would buzz in my ear or alight on my arm, and I spent a good part of the night just swatting them away or fidgeting like a cow.  How do people sleep without mosquito nets?  Malaria is easily treated, but the buzzing is maddening!

The boredom was as bad as the mosquitos.  My laptop had been stolen of course, and I’d forgotten my Kindle in Kampala, so all I had was my refurbished Samsung Galaxy for company.  And about 10 minutes in, the phone suddenly stopped working.  It would not turn on unless it was plugged in, and the only plug I had left was the car charger.

So I just sat there and stared off into space for the next 6 hours.  Occasionally when the mosquitoes got too annoying or I got too bored, I went to the car to charge the phone and try to doze.

But never for long.  I always had to get back to make sure Jolly was not trying to get up and walk around.  That was the only thing that kept me alert; every movement from Jolly stirred my senses as I prepared to… I didn’t know.  Ask him how he was doing?  Subdue him if he started walking around or thrashing in a way that could injure himself?  Adjust his IV drip?  If I woke up the night nurse from his stupor, would he know what to do?

THAT was the real worst part: being alone in a hospital with a severely injured patient and being totally clueless—helpless, in fact—about what to do if something went wrong.  How can a hospital leave patients alone with only untrained family members to act in an emergency?  How could the night-shift nurse think it’s ok to go sleep in a different room?  (Likely he works a second job or has an informal business during the day).  The District Health Officer is building a hotel, his deputy drives a Land Cruiser, and the patients in his hospital are lying on mattresses on a concrete floor against the wall being looked after by a Social Studies major from the US, farmers and cattle keepers from the village, and a sleepy nurse who looks like he may give up on life at any time even when he’s awake.

Don’t say Africa is poor because it has no money.  Africa has money: the rich steal it from the poor.  And no one gets angry.  No one demands change.  Everyone goes on smiling and relaxing, the only hint of their frustration being the occasional lament, “but what can we do?”  If you’re trying to understand why a barely-contagious disease like ebola is spreading so fast in West Africa, this may help you understand why.

(For the record, if anyone thinks to discipline the District Health Officer, please take away the Land Cruiser but let him keep building the hotel; I’d quite like to stay there if I am ever in Kaabong again.  Again, EXCELLENT water pressure.)

Continue to Part 5 >>

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3 responses to this post.

  1. Posted by Clara on October 6, 2014 at 9:32 am

    Dear Afrikent,

    I appreciate what you are saying and true Uganda still faces challenges in its health system. Your article raises concerns as you are using examples from Uganda to explain what is happening in others countries in West Africa. I believe the health care system in the USA, which clearly fails the poors, can not be used as a reference point. Neither can I use example from Mexico to explain the failures of Canada health system (you all are one country right?). I am from Europe (wait we are not one country) and we also have our own challenges.
    I have been working in several countries for the past 8 years and let me tell you that poor people in “Africa” are working hard to make things changes.

    Please ensure you give a complete picture.

    Cheers

    Reply

  2. […] Disaster on Kaabong Highway, Part 2 Disaster on Kaabong Highway, Part 4: Africa’s Health Care Systems Strike Back […]

    Reply

  3. […] Disaster on Kaabong Highway, Part 4: Africa’s Health Care Systems Strike Back Disaster on Kaabong Highway, Part 6: Home At Last […]

    Reply

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