We were driving in the ambulance from Kaabong to Kampala, and the roads were dubious at best. Fortunately we had an excellent ambulance driver. A native Karamojong, he had worked for more than a decade in the area with NGOs, bus companies, and the government, and he knew every pothole, ridge, and rivulet in every road along the way. Thanks to his skill, we were able to make excellent time while still driving safely, his expert hands knowing when to guide one wheel off the road when it was smoother in the grass, his eyes accurately judging the space between ridges in the road that would allow both wheels to ride atop them, straddling the rain-carved rivulet that ran between.
The scenery was beautiful. The volcanic plugs and dramatic cliffs of Kaabong soon gave way to a vast sea of gold-green grassland that stretched to the horizon, the waving stalks bathed in golden light by the setting sun that shimmered on hidden pools where the first waters of rainy season had already begun collecting. The road had evidently been resurfaced recently, as we encountered only a few muddy patches. We passed the occasional Karamojong wandering aimlessly by or resting in the grass, children crying “Dodo! Dodo! Dodo!”—their call for us to throw them a plastic water bottle as they ran after the vehicle. The pastoralist children prize the plastic bottles because their families use them to store milk, and when you respond to their clamours for “dodo,” they playfully fight over the bottle until the victor finally snatches it, emerging from the pile holding his prize aloft.
By 6pm we were in Napak, a surprisingly developed town for such a remote region—no doubt due to the money flowing in to the town’s missionary hospital. Napak has grid electricity, and even boasts a well-built hotel with a swimming pool. Why not take Jolly to this hospital? Simple: it does not have a CT scan machine.
We dropped off the first patient, her caretaker, and the two passengers who had hitched a ride, leaving me with the entire front passenger seat to myself. After 20 minutes we continued on our way.
The road to Soroti was surprisingly smooth. Two years ago I had taken the same road, and it was atrocious: the mere 100 mile journey had taken more than 6 hours, and we had encountered at least three trucks bogged down along the way. This time though there was no mud—even in the infamous Iriri section where the worst is usually found—and the journey took less than 3 hours.
The road from Soroti to Mbale, however, was even worse than I remembered. It’s not so much a road smattered by potholes as it is a pothole smattered by bits of road. Cars, trucks, and buses fight for the small ridge of asphalt remaining in the middle of the road that has not yet eroded away, which makes for a terrifying voyage. Sometimes the asphalt crumbles away completely, leaving rough dirt that heavy trucks bound to South Sudan rumble over and pulverize into greater oblivion. A massive swamp stretches on either side of this “road”: one false move and your car will barrel roll off the edge and into the murky water.
And it was raining. Heavily. It was probably the second or third heaviest thunderstorm I have seen in Uganda, and we were grateful for the lightning that flashed every two seconds or so, as it was the only thing illuminating our way. The rain was so heavy that the car headlights could only penetrate a few meters in front of us, so we had only the lightning to show us where the swamp began and the road ended, and whether there were any vehicles coming our way. The ambulance’s defroster hardly worked; it could only blow hot air, and we couldn’t open the windows on account of the rain, so we labored on, me sweating and the driver wiping the windshield every few minutes or so with his rag to clear the condensation.
We went on like this for two hours before finally arriving in Mbale. By this time it was midnight, and no doubt the hospital was closed. How can a hospital close?! I wondered.
But closed it was, and there was nothing we could do about it. The driver, nurse, and I held a small council, and decided it best to continue the remaining four hours to Kampala. It would be 4am before we arrived, but there was no sense spending a night in Mbale when Jolly needed medical attention as quickly as possible.
So we continued. By the time we arrived in Kampala, the driver had been behind the wheel for 13 hours. Jolly had not woken up once.
Our first attempt at treatment was at Mulago Hospital—Uganda’s flagship government health care facility. I’d heard stories about Mulago from medical students who worked there: patients sharing beds, equipment failures and medicine stock outs, accident victims bleeding to death while doctors WALKED over to see them.
But attempting to get medical care first-hand was eye-opening nonetheless. Health care at Mulago is free, but that’s about the ONLY reason you would ever seek treatment there.
No one was at the hospital entrance to receive Jolly when we arrived. No stretchers, nothing. So we left him in the ambulance as we went in to inquire about what we should do. No one was at the reception desk either. It took us about 5 minutes to find someone who worked there, who only informed us that the receptionist “had just stepped out, but he’s coming.” Sure enough, after about 5 more minutes, the receptionist plodded into the waiting area, yawning and rubbing his eyes. He’d obviously been taking a nap in another room, and looked none too pleased to have been woken up from it. If you are going to take a nap, at least do it at your desk!
The news he gave us was just as useless as he was: all the beds at the hospital were full. A digital display board that WAS useful told an even worse story: there were 93 people ahead of us on the waiting list. We could either leave Jolly on the floor for the next several hours, or take him somewhere else.
We took him somewhere else. And there was only one somewhere else we could possibly take him at this point, it had been so long: the International Hospital of Kampala (IHK).
IHK is the private hospital where expats and rich Ugandans go when they are seriously hurt. Again, there was no receptionist at the desk—but there was bell. And a few seconds after ringing the bell, a fully-awake nurse showed up at the desk to check us in. Amazing! There was also a doctor on duty. Double amazing! And plenty of hospital beds! And no line! And proper equipment!
Jolly was finally in good hands.
The hospital’s were not the only good hands Jolly was in. He’d been accompanied there by a colleague with a credit card, and we both worked for an international company that had been recently capitalized by nearly $2 million in VC funding—so I knew that any credit card bills I incurred on Jolly’s behalf would be reimbursed.
The immediate medical bills were more than $400, and we eventually paid close to $2,000 for a week-long hospital stay, visits by a neurosurgeon, and all the other expenses. By American standards that sounds tiny, but it’s more than 3x Uganda’s per capita GDP. By this measure, $2,000 in Uganda would be $186,000 in the United States. Many companies in Uganda would have probably chosen not to pay even if they had the money. After all, in Africa human life is cheap.
But Jolly didn’t work for one of those companies: he worked for BBOXX, which ensured his medical bills were covered. Since then we’ve bought health insurance for employees at all levels—a rarity in Africa.
And he had a good family who cared about him. The only mistake they made was that accident happened on April 1, so at first his family thought it was a bad April Fools’ joke. But once they realized we weren’t joking, they got there as soon as they could. His brother was the first to arrive. He’d been working on a project in Bushenyi, a 5-hour drive from Kampala, but he jumped on a night bus as soon as he heard the news, and arrived at IHK around 7am to relieve me. The rest of his family showed up soon afterwards.
Finally, I could go home and sleep.
Jolly was unconscious for another few days, making only small improvements—like sitting up or being able to sip juice.
Then, a week later, as I was sitting at the office, Jolly walked in.
His face was a bit bruised, but he recognized everyone and was talking perfectly. “I’m out now,” he said. “But… I’m really tired. I won’t be able to work today.”
Of course, Jolly .
“Did we finish the solar installations?” he asked. Always dutiful to the job.
I told him we had.
Satisfied, he went home to rest. Jolly has since made a full recovery. He’s back at work managing our warehouse and logistics in Uganda. Though he remembers nothing of what happened, he suffered only a few bruises and a small fracture in his skull, with no permanent damage. Seeing the car, it is truly a miracle.
War Child even made a second order to electrify one more school. This time things went more smoothly: no budget overruns, no car accidents, and no injuries.
Things could have been a lot worse. Jolly survived despite Uganda’s health care system, because he was backed by a company with the resources to pay for treatment outside of that system.
It’s a reminder to all of us in richer countries that our health care is more than the doctors, great as they are; it is a system that makes health care work. It’s the people in the back office who know which ambulance has wheels and which one doesn’t, who make sure that the ambulance has fuel BEFORE it needs to drive somewhere. It’s the sense of urgency ingrained in every health care professional, so they aren’t asleep when you arrive at the hospital–and even if they were, would run not walk to a patient as soon as you woke them up.
And yes it’s the wealth that pays for the system: extra ambulances so one vehicle doesn’t have to make two trips, extra beds so injured patients don’t have to sleep on the floor or share, and a system of credit so that the doctor can treat you now and get payment later if you don’t have cash on hand. This system takes people to make it work, and we should be thankful for all the people who do.
This is not to belittle the stressful and heroic work done by the Ugandan and other doctors at hospitals like Mulago and Kaabong Hospital. They toil away in spite of medicine shortages and power outages, for a fraction of what doctors in the West are paid. Often they are simply overwhelmed by the sheer volume of patients they must see by virtue of working at the only free hospital capable of treating serious ailments in a country of 35 million people. No matter how good these doctors might be, they are not backed by systems that enable them to do their jobs.
It’s a reminder that we would never want to find ourselves in a situation where our lives depended on our ability to pay–or on the health care professional’s willingness to work—to keep on living.