Abandoned by ambulances while in labour

Nothing is as irreversible as baby ready to be born. The urgency, the delicacy and vulnerability of the mother and the baby can make even the best preparations seem inadequate as Gloria Nalwoga, found out.

On her last antenatal visit, the expectant mother was told when her baby would be coming and she was confident with the doctor’s information. But this information seemed redundant when four days to her due date, Nalwoga went into labour.

Friday, April 24 started off like any other day in lockdown, but as it progressed, Nalwoga got the urge to use the bathroom frequently. As the visits progressed, she shared with her husband who advised her to resist the urges since this could be a sign of labour.

Nalwoga and her husband’s possible labour suspicions were lulled by an uneventful evening and they went to bed.
Towards midnight, the labour pains returned and this time they were unmistakable so they called a doctor at St Catherine’s Hospital who advised them to go to hospital immediately. As earlier advised, Nalwoga had dutifully saved the phone contacts provided by the government for emergencies such as these.

“We called all the phone numbers of the designated ambulance drivers which we had acquired earlier on TV but all went unanswered,” she recalls.
Now beginning to panic and confused, Nalwoga’s husband called a friend who shared with them contacts of both the police officer in charge (OC) of Nansana and that of the Wakiso District Police Commander (DPC). But it turned out fruitless.

“We called several times using different numbers and we again called the ambulance drivers but our calls went unanswered,” she says.
The couple also managed to get the phone number of the Wakiso Resident District Commissioner (RDC) Rose Kirabila and her deputy, but again, the calls went unanswered.

“I then asked my husband to talk to the LC defence official in Nansana B1 where we stay and he referred us to the LC I Chairperson who also doubles as our landlady,” she says.

The LC I Chairperson, however, informed the couple that she could not help because it was too late and her car wasn’t available at that time. She then referred them back to the RDC or the designated ambulances. As this back and forth was going on, Nalwoga’s labour was progressing and since she could not risk a natural birth she had to find means to get to hospital.

“Once again we tried the RDC’s office, the District Police Commander and the Local Council chairman, but still got no help. Our only option was to walk the 10 kilometres from our home to St Catherine’s Hospital on Buganda Road, Kampala,” Nalwoga recounts.

Nalwoga says she had watched TV programmes of women decrying the difficulties of accessing maternal services during the lockdown but never thought it would ever affect her since she was in the city. Also, she had the phone contacts to rely on for emergencies.

The walk
The couple called friends but they feared getting arrested as they drove to pick her up. “So we set off as my husband kept on calling his friends and mine as well. Our other hope was finding a Good Samaritan along the way who would drop us off at hospital,” Nalwoga recounts.

The couple also hoped that they could find a police or any government vehicle for a lift. “After painfully walking for about 30 minutes, a police patrol car came along and I cried with relief as we started waving to stop the driver but he continued past us,” she says.
Nalwoga told her husband that she would walk in front, such that any passerby driving would empathise with a pregnant woman.

“I think because I was in so much pain I kept coming up with these ideas that would help me get a car to take us to the hospital in time. Minutes later, another police patrol showed up and I flagged it down with both hands but the driver did not stop,” she says.

Meanwhile, the pain intensified, Nalwoga’s legs were trembling from the pain, exhaustion and she got dizzy.
“I thought of pushing the baby but then I remembered the doctor had said that it was impossible for me to do so. But I could not walk anymore either. I just sat by the roadside and prepared for whatever fate threw my way,” Nalwoga recollects. She vaguely remembers noticing an omnibus stopping and someone saying “Omukazi tumuyambe” because at this point her brain had started shutting down because of the excruciating pain.

The omnibus dropped off Nalwoga and her husband at the Bwaise roundabout, because the driver did not intend to go back to town. By this time, her legs were wobbly and she was hardly aware of what was going on around her. Her husband put her in a sitting position by the roadside and he started pleading with passers by to rescue them.

At the mercy of a cyclist
While most people ignored the distraught man’s pleas, one boda boda cyclist braved security wrath and took the couple to St Catherine’s Hospital on Buganda Road in Kampala.

The couple says their rescuer was indeed valiant. He sped past roadblocks and defied some flagging down by those manning the roadblocks until they arrived at hospital.

“All he [the rider] did was to give us his number and asked that after getting medical attention we send him Shs5,000 for transport,” Nalwoga recounts.
The couple was admitted at St Catherine’s Hospital where few hours later Nalwoga was able to go to a theatre where she was delivered of a baby girl by C-section.

Changing directives
Almost two months ago, President Yoweri Museveni banned the use of both private and public transport. However, some people deemed essential would continue moving. He informed the public, that they would be given permission to use their private cars in case of emergencies but after getting clearance from their Resident District Commissioner.

The president also clarified that sick or pregnant women would be free to move, but the implementation of this directive has been difficult. For women like Nalwoga who do not own cars, this has been difficult.

Even those who can access cars have at times been blocked by police, with one woman reportedly being forced to give birth at home, after she was sent back home at a roadblock, because the husband had taken her in a 14-seater omnibus that is normally used as a taxi.

In anticipation of such difficulties, a number of cars were supposed to be availed for emergencies. According to Peter Kaujju, the Kampala Capital City Authority (KCCA) spokesperson, they have a pool of 30 vehicles for cases such as Nalwoga’s.

“We have a pool of 30 vehicles for emergency response. This is a combination of ambulances and other government vehicles to respond to needs and they operate 24 hours a day serving people in the greater Kampala Metropolitan area,” Kaujju reveals.

Contrary to Nalwoga’s experience, Kaujju insists the ambulances are reachable on an emergency toll free numbers, adding that she might have called when the lines were engaged.

“We have a big line of clients that have been served and testify about the excellent service under emergency response. We remain on standby to serve members of the public when need arises,” Kaujju adds.

Asked whether KCCA had sufficiently financed the ambulance drivers to be on call for 24 hours, Kaujju replies in affirmative, but declines to reveal the amount of money that KCCA earmarked for things such as fuel and allowances for drivers.

The problem
Delay in accessing medical care for women about to give birth has been highlighted by United Nations Population Fund as being a major contributing factor to the 16 women that die daily in Uganda due to complications related to childbirth.

A tally of deaths availed to this newspaper, after it was discussed by members of a taskforce monitoring maternal health, shows since February; Uganda has experienced an increase in the number of women dying in child birth.

According to the tally, in the first week of February, eight women died in childbirth, by the last week of March, this number had risen to 76 women with experts predicting the months under lockdown would be the worst.
Dr Jesca Nsungwa, the Commissioner for Maternal and Child Health, says the increase in the number of mothers dying is expected, given the lockdown “These deaths are what we term as indirect deaths, in humanitarian situations,” she says.

Some experts, however, say that Covid-19 isn’t the kind of humanitarian situation that should have caused deaths of women giving birth, since the lockdown was supposed to have been planned.

Unlike war or natural disasters where government starts to plan after people have been displaced, the government could have implemented President Yoweri Museveni directives in a way that does not lead to deaths of women. “Pregnant women should never have been included in the ban on movement, “says Asia Russell the Executive Director Health Global Access Project.

Russell adds that even after the president lifted the ban on the movement of pregnant women, the response by different government agencies is still causing harm.