Friday August 22 2014

Kasese expectant women brave the national park to deliver in hospitals

 Patients take shelter under trees during the health workers’ strike

Patients take shelter under trees during the health workers’ strike over unpaid salary arrears in Kasese District last year. Health centres at landing sites in the district lack essential services. Photo by Misairi Thembo Kahungu 

By Misairi Thembo Kahungu

The picture that landing sites in Uganda creates in the mind of citizens is not a rosy one.

The landing sites in Kasese District are no exception. Six in number, Hamukungu, Kasenyi, Kahendero, Katunguru, Katwe and Kayanzi landing sites are lagging behind in service delivery. All the six are spread across Lakes George, Edward and Kazinga Channel.

Aside from other infrastructure, health service delivery at these sites is in a poor state compared to what the communities on the mainland receive.

Currently, it is only Katwe Landing Site (doubling as Katwe-Kabatoro Town Council) and Kasenyi Landing Site that have health centre IIIs where the communities can access maternity and Antiretroviral Therapy (ART) services.

Such remains a dream for Kayanzi, Kahendero, Katunguru and Hamukungu landing sites. Most of the big health cases in these landing sites are taken to Bwera, Kagando and Kilembe hospitals, which are between 40 and 50kms away.

In addition to the long distances, people have to brave the risks that come with moving through Queen Elizabeth National Park.

According to Mr Peter Kakule, the chairperson of the Beach Management Unit at Kayanzi Landing Site on Lake Edward, expectant mothers are rushed through the national park to Bwera Hospital when in labour.

Danger of elephants
They sometimes face obstacles along the way such as herds of elephants since the motorcycle is the main means of transport. However, the health centre II is rendering other services well.

“In Kayanzi, the health centre nowadays has staff and the drugs are delivered on time, but the biggest challenge is still lack of maternity facilities. The same challenge is faced by our people with HIV/Aids,” Mr Kakule said.

At Hamukungu Health Centre II in Lake Katwe Sub-county, Ms Nyesi Biira, a midwife, seems to be redundant. She is like a servant sent to the garden without a hoe to dig.

She says the health centre does not have maternity facilities where women can deliver from.

Her work is only limited to antenatal care to expectant women after which she refers them to a hospital for delivery. In most cases, they do not heed and opt for the Traditional Birth Attendants arguing that the hospitals are far away, she says.

Long queues
“I am not busy like I was in Kasangali health centre in Bwesumbu Sub-county where pregnant women for delivery overwhelmed me. Here, there is no maternity ward. I only sit and wait for Thursday when a handful of women come for antenatal care moreover without their husbands,” Ms Nyesi says.

According to Mr Yusuf Mawazo, the national programmes coordinator for Uganda Fish and Fisheries Conservation Association, much as the landing sites in all parts of the country are a little bit similar in nature, those is Kasese District are lagging behind on all government services because they are hard-to-reach.
Mr Mawazo said in addition to having bad roads, some of the landing sites have no clean water, poor sanitation projects and lack of access to modern public latrines.

He cites an example of Kayanzi Landing Site where the only public latrine constructed by the local government was abandoned due to shoddy work about four years ago.

“All landing sites in Uganda look more less the same in nature, save for those in Entebbe, Kampala and Jinja that are close to administration centres.

They receive good services compared to those in Kasese,” said Mr Mawazo, whose organisation has been working on landing sites for five years.

State of structures
At Hamukungu health centre II, it is by the grace of God that the main block that includes a treatment room, the office of the in charge and the drugs store has not collapsed because it is dilapidated. On arrival, one is welcomed by the bats that have also littered the would be main hall with their waste.

The in-charge was not on duty when we visited the health centre. The nurses available open the centre and wait at their residences for any call for help. The wild pigs make use of the compound as a playing field.

The chairperson management committee, Mr Abdul Karim, says the health centre with a committed staff of five people, currently needs new structures to cater for a maternity ward to reduce on the risks of women delivering in the middle of Queen Elizabeth National Park on their way to hospitals.

He said in 2012, a woman delivered twins just about 4 kms inside the national park as she was being rushed to Kilembe hospital 45 kms away. She has since relocated to Kainja landing site in Kamwenge District.

What has been done?
However, the Kasese District local government is doing its best to balance the health services on landing sites with the mainland, as is revealed by the secretary for social services, Mr John Businge.

According Mr Businge, aside from posting more staff and intensifying the supervision of drugs, health centers in Kayanzi, Kasenyi, Katunguru and Hamukungu have received some fairly good buildings.

Some work needs to be done at Hamukungu Health centre II and Katwe health center III to have the maternity wards fully operational.

“With little budgetary allocations to the health sector, we have tried to construct houses at health centres in Kayanzi, Katunguru, Kahendero and Kasenyi in the last three years.

At Kasenyi we got support of the development partners who have helped upgrade the centre to the level of three. We are planning to renovate the maternity ward in Katwe and also build one at Hamukungu,” Mr Businge said.

Mr Businge revealed that Shs20 million was spent on the construction of a solar powered gravity flow scheme that supplies Hamukungu landing site with water.

What is needed?
Mr Yusuf Mawazo, who has experience in working with fishing communities in Uganda, calls for a bottom up planning.

He said the Kasese District local government should carry out a special needs assessment at the landing sites so that the people are able to point out what they want to be done for them.


The way of life at the landing sites in Kasese is not different from what other landing sites in the country are experiencing.

The men concentrate on fishing as the women remain at home doing domestic work. The flourishing businesses do not exclude bars and lodges which has to a large extent contributed to the exploding spread of HIV.

According to HIV/Aids activist attached to the national council of women living with HIV/Aids, Ms Rehema Aryema, who has been traversing the landing sites sensitising the masses about the prevention of the scourge, the people care less about protected sex.

“The men at the landing sites only enjoy booze and sex. This increases the spread of HIV as women and youth are also not spared in their way of life. It is not easy to control this at the landing sites as the mindset of the people about positive living remains highly negative,” Ms Aryema said.

Releasing the report on status of HIV/Aids early this year, the Kasese District HIV/Aids focal person, Mr John Thawite, pointed out the landing sites are among the scourge’s major hotspots.
Quoting the 2012 national Aids indicator survey, he rated the prevalence rate of Kasese District at about 11per cent which is higher than the national rate of 7.3 per cent.

Majority of the cases are recorded in communities along the lake shores.

However, in some areas where persons living with HIV have disclosed and accepted positive living, the government has not yet extended the services to them fully despite some efforts by nongovernmental organisations.

Mr John Bosco Onyango a resident of Katunguru landing site says that much as the health center II in the area has been given ART services, the staff are not yet committed to the patients and usually absent themselves from duty.

He says on some days patients have turned back without a service due to cases of absenteeism.