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NEW VISION, Monday, May 2, 2016


34 NEW VISION, Monday, May 2, 2016 HEALTH & BEAUTY

Bad roads affecting ambulance system

Uganda’s health care system is grappling with many ambulances grounded due to minor and serious mechanical conditions. Even those that are functioning are not providing high quality services . In some areas, transferring patients to referral hospitals is not easy. In a three-part series, Andrew Masinde explores the state of the ambulance service in rural areas

T ransferring patients to referral hospitals is not easy in rural areas. The roads are bad and many people have ended up

losing their loved ones because they

failed to reach the referral hospitals. Indeed this is backed by statistics for instance, for the case of maternal mortality. According to the 2011 Uganda Demographic Health Survey report, maternal mortality rate was found to be 438 per 100,000 live births. After being told by one of the residents of Bukwo district in eastern Uganda, that if a patient is referred to Kapchorwa Hospital during the rainy season, it is better to return home than to waste time travelling, I decided to prove it myself. On a chilly Thursday morning, I set off to Bukwo. The journey from Soroti to Kapchorwa via Mbale was smooth, giving an impression that the whole journey would be smooth. However, upon reaching Kapchorwa town, I was told the road was bad. As I was looking for a taxi,

a bodaboda rider told me that pickup trucks and lorries are the main

means of transport and that the fare

is high because of the bad road.

“The fare is between sh25,000 and sh30,000 to Bukwo, yet it is just 77km and the journey takes

six to eight hours,” the cyclist said.

It is estimated that the fare from

Kapchorwa to Bukwo would be sh7,000 and the journey would take 45 minutes if the road was good. I moved to a heavy duty Nissan pick-up truck on which 23 of us

were loaded like sacks of charcoal. The truck also had carrots and Irish potatoes, which belonged to

a few traders who were part of the

passengers. After setting off, we travelled for two kilometres, before reaching a murram road. One of the passengers alerted me that hell had started and that I should brace myself. The road is full of bumps, slopes,

hills and rocks. The corners are very sharp and narrow, yet the driver was reckless. Other passengers seemed not to mind the speed People seemed comfortable with the speed, yet my heart was threatening to leap from my chest. The driver was negotiating corners and cliffs and at some point

I was afraid the vehicle would

overturn. Thank God we reached Bukwo town safely. Early in the morning, the following day, I decided to visit Bukwo Health Centre IV for an interview with the in-charge, but I did not find him. I decided to travel back lest I would miss the second vehicle to Kapchorwa. There are a few vehicles that ply that route. Upon boarding

There are a few vehicles that ply that route. Upon boarding A truck gets stuck on

A truck gets stuck on one of the roads in Bukwo. The bad roads cannot allow ambulances to drive through hence making it difficult for patients that need emergency care to get medical attention

the truck, we travelled for about 20km and then the heavens opened up. Though the road became slippery, the driver assured us that we would reach Kapchorwa safely. However, the further we went, the worse the road became, until the vehicle could not handle anymore. It rained heavily for over six hours, and thereafter it drizzled the rest of the day. He decided to park the vehicle after it failed to move on the slippery road.

And when the rain stopped, we had to push the vehicle such that we could get away from the slippery

areas and wait for the road to dry. After three hours, the road dried a little bit, so we pushed the vehicle back on the road and resumed the journey. We travelled for 11km and

the driver lost control and swerved off into the trench. We all got off and started pushing in vain. We left the vehicle behind and walked to the trading centre for a distance of about 11km. At the time, it was coming to 4:00pm. We were lucky this time the driver negotiated the muddy road until we reached

time the driver negotiated the muddy road until we reached Kapchorwa. Indeed, this was a true

Kapchorwa. Indeed, this was a true reflection of what would happen if there was an emergency case. Imagine if the patient’s only time for survival was four hours, but here you spend 11 hours on a 77km-road from Bukwo to Kapchorwa.

Northern Uganda After that experience, I headed to Lira to compare notes with Kapchorwa Lira. This side was worse than the route to Soroti. The road

“Sometimes, the patients are asked to fuel the ambulance because the fuel the hospital receives is notenough.”Byenume

was flooded at some points, and it also becomes muddy during the rainy seasons. In some cases, the vehicle swerved off the road, but thanks to the driver’s experience we did not have to push the vehicle like in Bukwo. The journey took four long hours. Indeed, if the ambulance had to make a return journey, it would have to spend most of the time in a garage.

Hoima On my fifth day, I travelled to the western part of Uganda and my destination was Hoima district. It was a smooth ride from Kampala to Hoima as that road is tarmacked. Thereafter, I decided to visit Kabwoya Health Centre IV, which is 45km from Hoima town. In this part of the country, public transport involves saloon cars, not minibuses. Since the car was small, the operators had to pack in as many passengers as possible. For 45km, we were charged sh7,000 each. The passengers were packed like beans and had no breathing room. At the health centre, I found one nurse, Saidat Babirye, attending to patients. She gave me 10 minutes. She said Kabwoya Health Centre gets sometimes three to four cases of patients who need referrals and most times they are expectant mothers.

AmbulAnce use in kArAmojA

After Bukwo, I decided to get an experience of accessing referral hospitals when in Karamoja. I started on a journey to Abim district, which is 132km from Soroti. The road is full of bumps and mounds and it felt like I was travelling in a sweet potato garden. The dust rises and by the time you reach Abim it is like you are from a construction site.

However, the journey was not that long, because the road was dry, and after three hours I was in Abim. Early in the morning, I visited Abim Hospital, where I interviewed the hospital administrator about the challenges faced after patients are referred. Bradford Okori, the Abim Hospital administrator, says the hospital

serves a population of 95,610 in the district and 17 lower level health care facilities (health centre IIs and IIIs) and neighbouring districts in Lango and Karamoja region. He says accessing the main referrals is too costly. The hospital had six ambulances, but all had broken down because of the bad roads, so taking a patients to Soroti or Lira takes about four hours, yet the journey could be 45 minutes if the road was good. “Four years ago, we decided to stop collecting patients from health centres and also from their homes because accessing them is very difficult. This partly is what causes the ambulances to break down because the terrain is bad and the roads are too slippery,’ he explains.

She said on several occasions, they would refer patients to Hoima referral hospital, but after a few days, they would receive calls that the patients had passed on because they could not get transport to Hoima Hospital. “The Government needs to work on the roads because if people are to access referrals, then the roads should be good in order for the ambulances to move fast,” she said. While we were still talking, it started to rain heavily. I went to the stage hoping to get a taxi. However,

all the taxi drivers were not willing to travel as they had heard that the road was slippery. I negotiated with the driver and we agreed on a fee. The first few kilometres were not bad because the road was not slippery. However, 11km to Hoima town, things took

a turn for the worse. The road was

muddy and slippery. The driver began complaining, but I offered to push the vehicle until we got to a better place. We tried our best until we reached Hoima and I was asked to pay an extra fee, which I gladly did because

of the hurdles I had seen him suffer.

I just imagined what would have

happened to me if I was a patient in need of urgent treatment. Would I have pushed the vehicle? Francis Kahwa, a resident of Bitamba village in Bwijanga sub- county in Masindi district, said bad

roads almost cost his brother’s life. It was at 3:00pm when he received a call from a friend that his brother had been involved in an accident. “I rushed there and he was critically injured. I took him to the health centre from where he was referred to Mulago Hospital in Kampala for a knee operation. I looked for means of transport in vain. Later, we were lucky that we got a taxi. However, the driver told us to let other people squeeze in, but it was risky for the patient to travel this way,” he said. He added that they could not travel in that taxi, so they decided to use

a bodaboda to Hoima town, from

where he got transport to Kampala. The district health inspector of Hoima, Fredrick Byenume, said Hoima referrals face many challenges that include lack of enough ambulances in the hospital and health centres. If you are lucky and the only ambulance at the main hospital is there, then sometimes you may not survive to buy fuel because the little they get is also used for a generator, which at times works 24 hours because of frequent power shortages. The hospital has only one ambulance that was given to them after the Commonwealth summit in 2007. Because of the frequent

movement of the ambulance, the fuel

is not enough, so patients have to

foot the bills, which at times delays the referrals. They pay for fuel only when they have an emergency that needs referral and it depends on the distance of the referral and many cannot afford it. In urban centres, all the public ambulances are free-of-charge.

In tomorrows New Vision, find the second part of the series which reveals the percentage of the ambulances grounded. This story was supported by African Centre for Media Excellence (ACME).