Pre-colonial Bunyoro’s healthcare beats Uganda’s

I had gone last month for a check on the state of my vital organs – heart, prostate, lungs, pancreas, liver, bladder, the lot – when the doctor inquired about the surgical mark I had some place. I explained the surgery that happened 12 years previously, revealing that it had been done by Ignatius Kakande.

“Ah, Prof Kakande!” lamented my doctor. “He is in Rwanda. I do not know why Uganda cannot look after its doctors.” Another highly skilled medical practitioner lost to Uganda, Kakande had for long been one of our best surgeons. I can only second-guess the good old surgeon - I would bet that he went for the financial returns and the more conducive environment.

Surprisingly, Uganda has done better in the distant past. Researching our history in the Independence Jubilee season, I came across staggering but little-known reports of how some old communities were well-advanced in healthcare. Historian Shane Doyle writes in ‘Crisis & Decline in Bunyoro’ (The British Institute in Eastern Africa with James Currey/Fountain Publishers/Ohio University Press, 2006) how there was preventive healthcare, including “several reports of pre-colonial Banyoro protecting water sources from contamination, maintaining good hygiene, and consuming herbs to prevent malaria and stomach infections during dangerous seasons.”

He talks of “a close relationship between the state and traditional healers. Kings gave healers ‘land spread in the different areas so that their services reach more people.’” What this speaks to me is that economic opportunity was availed, in the form of land, to attract the healers to different areas. I submit that economics is the reason most of our contemporary medical practitioners remain in Kampala (and why health facilities upcountry are short of staff – official statistics show that of 7,300 required staff in 40 general hospitals, 2,964 posts are vacant; and in 853 Health Centre IIIs countrywide, 8,034 positions out of 14,872 are vacant of professionals like medical officers/doctors, anaesthetists, pharmacists, nurses, dentists, midwives, laboratory staff, clinical officers). (The Ministry of Health human resources audit report says that the proportion of approved positions filled by health workers is 56 per cent and vacancies are 44 per cent).
By giving their healers land in far-flung parts of Bunyoro, the pre-colonial kings were availing economic opportunity. Can’t we do similarly today?

Travelling in 2006 in a foreign city, I met an old friend, a neurosurgeon, and he lamented how he had written to Ugandan authorities requesting for help in financing the purchase of a piece of equipment that is vital for neurosurgery. That machine is too expensive for an individual to invest in on their own, and he wanted a public-private arrangement that would enable him come home, and save the country from referring complicated cases to overseas institutions. He got a negative response; his skills are still being enjoyed by another country.

Doyle also records how after an outbreak of sleeping sickness in 1886-87, causing many deaths, Omukama Kabalega ordered a Munyoro healer “to make experiments in the interest of science”, which were “eventually successful in procuring a cure.” Doyle reports J. Roscoe, a colonial anthropologist, being told that Kabalega sent men to learn about inoculation small pox inoculation from an Egyptian garrison.

Perhaps the most staggering is a chronicle by JNP Davies of the observation of surgery by caesarean section by ‘native’ surgeons in 1879. The place was Kahura, near Mruli (presumably present-day Nakasongola). A missionary doctor, Robert Felkin, observed as the patient/mother was anaesthesised with banana wine, incisions made, the baby removed, the bleeding stopped with red hot irons, and the wound stitched. Felkin’s description was published in the Edinburgh Medical Journal in 1884, and the ‘native’ surgical knife, which he took, he eventually presented to Sir Henry Wellcome, and stored in the Wellcome Historical Medical Museum (Wellcome is the world’s second-largest medical research funder).

The Government has done wonderfully in setting up health infrastructure (1,454 Health Centre IIs, 853 Health Centre IIIs, and 164 Health Centre IVs), but is yet to produce sufficient personnel, let alone incentivise them to serve there. Makerere Medical School passes out about 90 MB ChB degrees, 20 dentists, 15 pharmacists and 10 radiographers a year, while others come from Mbarara University of Science & Technology (50), and Gulu (40). Not enough.

WHO says “the main constraint is the inequitable socioeconomic development of rural compared to urban areas and the comparative social, cultural and professional advantages of cities. Cities also offer more opportunities to diversify income generation”. WHO’s website says the World Bank “has made recommendations to tie access to professional education to a commitment to practise a certain number of years in the country or reimburse the costs of training, to limit opportunities for training abroad, and to finance professional education through loans to students that need not be reimbursed when they accept work in an under-served area.”
Or do as Bunyoro did. It’s back to the future.
dsseppuuya@yahoo.com