Public Health Challenges of Uganda

I had an assignment to journal during my six-day public health elective last week and it doubles as an easy blog post! Dr. Paul was our program coordinator and we did the elective with three Makerere students, Lisa, Badru, and Moses.

During the first three days of the program, we went to lectures on the salient public health issues of Uganda. These included safe motherhood, HIV/AIDS epidemiology, nutrition, and issues of gender violence in a conflict setting. There was so much that I learned and I would love to share, but it is not exactly blog-worthy material. If you want to learn about any of these topics please let me know and I would be happy to send you my notes! 

The second week of the program was spent in Jinja, learning about healthcare on the ground level. We first visited the Jinja waste management facility. The biggest difference between American trash and Ugandan trash is that almost all of the waste here is organic. Thus the facility can be entirely devoted to composting waste. In theory, they were effectively dealing with the city’s waste by ensuring that it did not remain in the streets the pollute the water, nor get burned by households and pollute the air. But, despite the good intentions, the local government was struggling for the funding to keep the project running and the facility had deteriorated to the status of being barely operational.

On Tuesday we visited a health center IV (the highest level of village health center)  that served the Jinja population. Badru, Moses, and I started a discussion with the patients and caregivers in the waiting about Malaria and Typhoid because those diseases can be reduced in risk by increasing personal hygiene and the sanitation of living quarters. We learned that the majority of the patients were coming in because their children had a fever they assumed was malaria. When asked if they slept under bed nets, the majority said that they did but did not like it so they forgot sometimes. Others reported that the government distributed bed nets were of poor quality so they used them for other purposes such as covering nursery beds and protecting their chicken. 

We asked them to identify the main causes for malaria and typhoid and they could only identify malarial causes. The patients claimed that they had no knowledge of how typhoid was spread, how to prevent it, nor the symptoms to recognize. One man said that the doctors do not even tell them the disease they have; they simply give a prescription with no explanation.  We then went to the lab and asked them how they test for typhoid and malaria. Sadly, it is too expensive to perform a typhoid or malaria blood culture so they simply do an antibody match for typhoid diagnosis and malaria. The problem with typhoid is that there is salmonella (the bacteria that causes typhoid) in any food that contains eggs so the test is not accurate. The only accurate measure they can use to diagnose typhoid is when there is a large population that is sick so they can identify the epidemic as typhoid. Until that point, they never assume that the sickness is typhoid.

The only examination bed in the hospital

All health center IV's have this sign outside

The waiting area of the Health Center IV

That afternoon, we culminated all that we had learned in the Public Health elective by teaching reproductive health in a secondary school. We split up into teams of two and I was with one of our guides from Jinja so I essentially taught alone. We wrote notes beforehand on the common STI’s and contraceptive services so we would teach a uniform curriculum. Many of the students had never had an open conversation on sexual health so the more information we could illuminate, the better. After lecturing the students, we passed out paper so they could write down anonymous questions about reproductive health. The types of questions we were asked were astonishing because they enlightened us on how uninformed the students really were. They ranged from how exactly sex works, to whether birth control protects against STIs, to how to help a friend who is HIV positive. Aside from technical questions, I also had to debunk many misconceptions the students had on sexual health matters such as condoms causing cervical cancer and washing genitals with soap causing infertility. The most surprising thing I learned was that most kids did not understand the mechanics of how condoms can prevent pregnancy and STI spread. There is so much lack of communication that kids begin having sex before they have a conversation with an adult about how sex works.

Meredith and Moses teaching about reproductive health (that cylinder drawn on the board is Moses' attempt at explaining the female condom)

Visiting the school was a wonderful conclusion of everything we had learned in the public health elective. Much of what we learned in our lectures was that lack of power and education are drivers of poor health in Uganda and this was illustrated perfectly by what we saw in the school. Most students were unaware of the dangers unprotected sex can really pose and many girls feel that they did not have the agency to demand the use of a condom during sex. Knowledge of reproductive health is essential in increasing the health of the Ugandan population. With this knowledge in their arsenal, young people and adults alike can prevent themselves from contracting HIV and unwanted pregnancies. HIV/AIDS, illegal abortions, and families with a large number of children they cannot financially support or feed are huge causes of death in Uganda. Effective reproductive counseling at an early age can prevent all three of these conditions and improve the country’s public health.