When epidemics visit, Uganda becomes a different country

Wednesday March 18 2020

 

By Charles Onyango-Obbo

With Somalia recording its first coronavirus (COVID-19) case on Monday, all countries in the wider East Africa have reported a positive case, except Uganda. Because it will come, Uganda will therefore be the last East African country to report a COVID-19 case.

Uganda generally does well (in the end) at this virus control business, starting with HIV/Aids in the late 1980s when it led the way for the world actually, in deploying public education campaigns, openness, banishing superstition and seizing science in dealing with the peril, thus becoming the first country to roll back the rampage of HIV/Aids.

You could not step on a newspaper anywhere in the world at that time and find a report on HIV/Aids that was praising the Ugandan example.

To partly understand why Uganda does well, the point needs to be made that we excel if the success in combating an epidemic doesn’t require as the main factor a world class health system (because ours is abysmal), but a mix of some of that, social organisation, political commitment, and speaking truth to tradition.

That is what helped defeat HIV/Aids, Ebola, and might save us in the battle against COVID-19 when it comes.

The path that took us there was long and winding. Many commentators have said we won a lottery to have Dr Jane Aceng as Health minister because she has shown exemplary leadership.

Advertisement

You can think of how this could have gone horribly with one or two of the previous ministers of Health.

The other often unappreciated fact is that President Yoweri Museveni is a germaphobe, and there are a thousand stories of him sneaking off to wash his hands after greeting the hollo polloi, being touchy about surfaces, crockery, and so on.

However, the HIV/Aids ravages of the late 1980s and 1990s also posed a threat to something Museveni understands even more than germs – it was going to destroy the UPDF, and therefore his power.

When you have a president who is a germaphobe, a militarist, and loves his power, those fears and desires have the effect (even if some are unintended) of getting you high level presidential support for enlightened health approaches that you wouldn’t ordinarily receive.

At the height of the HIV/Aids pandemic, the churches and powerful conservative forces, would have made it impossible for the pro-condom and explicit sexual behaviour messaging that helped the country win the battle against Aids.

Some bigger developments followed. The HIV/Aids threat of that period led to a dramatic rise of meritocracy in public health in Uganda, and opened a pipeline for public-spirited doctors, going back to the wonderful Dr Sam Okware at the Aids Commission, onward to Dr Warren Namara, and so on.

That tradition, despite many headwinds, has not yet died in the nation’s public health sector, and continues to serve it well in epidemics.

In the country’s worst Ebola outbreak in 2000 in northern Uganda, even if the region was still at war, it was contained fairly quickly in the north, hardly crossing the Karuma. On October 14, 2014, Samuel Olara wrote an incredible story in the Daily Monitor, on the heroic Dr Matthew Lukwiya, who gave his life fighting the virus in Gulu.

When a World Health Organisation (WHO) delegation arrived in Gulu on October 15, 2000, Olara wrote, ‘they were astonished at the efficiency of the operation” to fight Ebola at St Mary’s Hospital, Lacor, where Lukwiya worked.

“Finding that their assistance was not required at St Mary’s, the WHO and Médecins Sans Frontières rapid response teams offered their assistance at the government’s Gulu Regional Referral Hospital…’

Since then, there is no major Ebola outbreak in Africa in which Ugandan doctors haven’t been key players – or died.

Crucially, the Ebola outbreak in 2000 was the last nail in the coffin of Joseph Kony’s Lord’s Resistance Army (LRA) rebellion. That is because Ugandans, in part because of the history of our wars, and the HIV/Aids epidemic, in the end tend to swing rather sharply away from voodoo and toward the more scientific explanation of diseases, and to embrace rational approaches to combating them more quickly than in many places in Africa, and without much dissent.

When the superstition-peddling LRA were asked for a scientific solution to Ebola, they didn’t have one. It took a while, but they were done at that point.

We could go on, but the one point that needs making before closing, is that the many years of conflict and displacement did many things, including shifting social power into the hands of women who, when it comes to these public health issues, tend to make better decisions than men.
So, we got lucky. But, mostly, we bled for our public health smarts. Hope both hold this time.

Mr Onyango-Obbo is curator of the “Wall of Great Africans” and publisher of explainer site Roguechiefs.com.
Twitter@cobbo3