Health and our education in Africa

Why did I(we) come to Africa? Was it to forge new relationships with peoples of different cultures in order to breach walls created by ignorance? Or to understand how they think and act in order to gain firsthand experience regarding theories and concepts we read about in class? What will we do with this information? Will their time spent sharing themselves with us be rewarded in the future by our more educated decisions? Or are we here to add something that looks good on a resume? To further ourselves academically? What boundaries are there in the quest for knowledge when it comes to intruding on the lives of people?

I have been dealing with these questions on a regular basis throughout the first weeks of this program. I try to understand my motives and those of the other students on this trip for coming here. These questions were especially brought to the surface when we decided to visit a local health clinic at the tea plantation. We arrived there in our normal fashion, in large lumbering trucks from which we pour out of and raid the premises searching for answers to questions posed to us by the professors. This clinic, which is no larger than my apartment, and has a total staff of 5, serves the health care needs of all of the workers from this plantation and their families, which number in the thousands. We showed up at a peak hour, so there were at least 20 people waiting outside to be served. However, the fact that they were busy didn’t seem to deter the mission of our group who walked into this cramped clinic and starting asking the nurses and medical officers a long series of questions, which they were only too kind to answer. We were there for over an hour while these patients NEEDED these health care workers and the facilities. The displeasure of these people was apparent and very justified. I can imagine waiting in an ER in Canada while hurt or sick and having a group of students or researchers come in and take over the entire facility for a purpose which is not absolutely urgent. I would be quite pissed off! I assume that is similar to how these people who obviously have priority must have felt. Actually if this were to occur in a hospital or clinic in Canada, we would quickly be asked to leave if not escorted out by security and asked to make an appointment like everyone else. But the people here are too friendly to tell us to get lost. As much as this is a learning experience for us, we in fact seem like a novelty to many locals and in their kindness and own curiosity have so far humored us in answering our strange actions and questions. However, I felt like in this context, we crossed the line. It seems that because we are on this noble academic mission that we have a certain sense of entitlement to any information we want in these countries. No matter under which context it is gathered.

I was not alone to feel a sense of discomfort at the situation we had placed ourselves in. I vocalized this disapproval in our follow up debriefing session. Many other students quickly chimed in agreement and asked our professor why we would even dream of intruding here when we saw it was so busy. We are blessed with flexible schedules and great mobility with these trucks, while the patients have jobs and farms to tend to and have to walk a minimum of 3 km to reach this place! We had come here to learn about the problems facing this community as well as its accomplishments, however, how could we expect to gain the respect and trust of the people here when we so blatantly disregarded their needs and rights? I was not satisfied by the response that people in these countries are used to waiting long periods of time for medical services, especially since we were the cause for this delay. I asked our Kenyan TA’s Jacinta and Usuf how they felt about this particular excursion and they admitted that they were shocked by the approach taken by the professor and the group. I understand that as a program, we do have schedules of some sort to keep and that is difficult to mobilize 17 people from site to site, so opportunities must be grasped when they arise, however I do not believe it should come at the expense of the people in the area.

I must admit that due to my lack of receptiveness to the approach, my participation was limited and I probably missed a great opportunity to ask important questions regarding the health needs and services provided to the local communities. If I were to return, I would modify the approach in that I would come with a smaller group, or if I was to come with a larger group, I would insist that only one staff member speak to us in a location that would not noticeably disrupt the functions of the clinic. Or even preferably, I would come alone and sit in line with the patients and wait to be served like everyone else. This approach I feel would allow me to even speak to patients waiting in line, and learn their stories and perspectives. My waiting in line rather than cutting ahead with a sense of superior entitlement would evoke a more positive reaction and perhaps even gain some respect from the local people. Perhaps I am also naïve and idealistic.

With the memory of this visit I approached the excursion the following day with a great deal of apprehension. This time we were driven to the public hospital in the nearby city of Fort Portal. However, our professor did take our criticisms seriously and addressed our concerns. When we arrived, we were split into two groups and given a tour of the facilities by 2 staff members. Our presence was less obtrusive as we allowed the hospital to continue with its normal functions despite our presence. We would occasionally stop to talk to nurses or doctors, but would not delay them by more than 5 minutes, especially considering the amount of work they faced. I thought I had seen bad hospital conditions during my trip to the Dominican last may. This hospital made the Dominican hospital look like a 4 star hotel compared to a ratty hostel. The maternity ward was particularly striking. There were 2 nurses/midwives working to help an uncountable amount of post-natal mothers and their babies. The ward was so jammed packed with patients that some mothers, who we were told had just had a cesarean section performed on them due to complications during birth, were accommodated on the FLOOR! IV bottles were hung off of doorknobs! The head nurse told us that she didn’t even have a single blood pressure cuff for the entire pre/post natal facility! One thing that she said struck me as particularly poignant. She kept stating “we can’t even do what we were trained to do.” Short staffed (9 doctors and 60 nurses for 2000 inpatients and 3000 outpatients and ONE ambulance) and without adequate basic medical supplies, the thought of: “what else is a hospital than a building where people go to die?” kept going through my mind. No wonder average life expectancy of Uganda is in the 40s! And that the maternal and infant mortality rates are so dammed high! The lack of a blood pressure cuff for the maternity ward struck Doctor John as a particularly hard fact to accept and over lunch he set out to find a pharmacy where he could buy one. (A decent one with a stethoscope is only 20 USD but even that seems like too much for the medical ministry of Uganda to provide.) Later in the day, he and I delivered it to the head nurse, who was almost speechless when we presented it to her and excitedly hurried off to use this new tool to help her patients.

In the afternoon, we visited a private clinic funded by the Catholic Church. The facilities were comparable to a North American one. The only similarity it shared with the public hospital was that families of patients had to take care of providing food for the patient. For a small fee by our standards, a patient could be provided with adequate medical care, with calm, well supplied, well educated and not overworked staff. The hospital was on a hilltop in a posh part of town, allowing for a persistently cool breeze to pass through the wide open spaces available to families of the patients while they wait for their loved ones to heal. The public hospital was in a humid valley with a sewage-filled river flowing next to it. However, the small fee (under 10 dollars a day) is an exorbitant amount by the standards of most Ugandans. However, those who can barely afford to get treatment here choose to do so, knowing that although they are risking their family’s financial security by seeking treatment here, their chances of surviving are much higher. What DID strike me as odd about this hospital was that like the public hospital, the top 3 reasons for children to be sent to the hospital was Malaria, Malnutrition, and GI disorders. I can understand if a poorer family cannot afford bug nets, or nutritionally sufficient food, or to provide enough fuel to boil water, but a family that can afford to send their child to such a nice hospital can surely take the measures to prevent that such a hospital visit even need to occur! Perhaps it has something to do with the fact that almost all public awareness campaigns in Uganda and even Kenya are launched in English rather than local languages. Not many people are fully fluent in English, and even fewer are literate in English. Thus, all this rhetoric about money being spent on public awareness campaigns by governments may be true, but how many people can actually GET the messages?

Amani My Friends.