With her brown eyes sunken, Ms Ruth Nansasi looks haggard as a result of a six-month pregnant. She had surrendered to fate when journalists on an assignment stumbled upon her.
She lives in Kalangala District, an archipelago of 64 habitable islands interspersed with lush vegetation offering an idyllic view to tourists.
For four days, she had waited for her family to raise Shs40,000 to move her to Masaka Regional Referral Hospital in vain.
Nurses at Kalangala Health Centre IV had told her that they could not treat her reproductive health complications.
“Can you please help, because if you don’t we also don’t know what to do,” a genial nurse asked us.
“She is not that critical but her condition keeps changing. We referred her to Masaka four days ago but she does not have the means nor can she go back to where she came from — on one of the islands about 40kms away,” she added.
Being her first pregnancy, Ms Nansasi is scared she could face the plight of other women. On these islands, it is common sight for women to give birth on boats and ferries or landing sites while waiting for help.
The islanders say the lake is often calm around this time of the year but the season between May and July, accidents are rife.
“It is traumatising but what are the options?” Ms Nansasi asked.
We hired a boat and offered to travel with her to Masaka as the health centre wanted her to leave to create space for other patients.
Both attendants and residents Daily Monitor talked to, revealed that stranded patients return home to die when they cannot afford transport. Others are said to rely on traditional medicine as a last resort.
Referrals are common in any healthcare system. According to the World Health Organisation, an effective referral system ensures a close relationship between all levels of the health system and helps to ensure people receive the best possible care. But this is not the case for Kalangala District.
Mr Fillian Kerunega, a senior medical officer at Kalangala Health Centre IV, explained that the referral system in the case of Kalangala “is expensive because first of all, patients travel here for long distances by boat. The additional costs to move to either Masaka or Entebbe just makes matters worse.”
“Most times when we go for medical outreaches, you are told that so and so died because they failed to get treatment or the patients just retreated to wherever they came back from — sometimes aggravating otherwise small health situations,” he said.
Kalangala Health Centre IV, the best health facility in Kalangala District, is in a near-to deplorable state and is handicapped as a result of poor facilities, low drug and staffing levels yet it serves a population of about 10,000 in its catchment area.
As a result, the facility, which is a referral point for nearly all patients from the rest of the 64 islands, has to routinely refer patients to the nearest destinations — Entebbe Grade B Hospital, which is 111km or three hours away or Masaka hospital, which is also three hours away.
“It is difficult for us to provide the right services,” Dr Kerunega said.
“This added to the fact that we don’t have fully-fledged water ambulances. Imagine patients being transported in the open regardless of the weather or not, the expectant women is being moved on a rough lake,” he added.
MP speaks out
The Kyamuswa County MP, Ms Carol Nanyondo, said: “There is no one, from the President, Prime Minister to the Health minister, who has been to Kalangala and they are not troubled by what residents go through.”
“They all keep promising to upgrade that health centre IV into a hospital but it ends there. We have written several letters reminding them, done workshops and everything we can but all this has been in vain,” Ms Nanyondo said.
“As leaders, we will keep talking but there is nothing that the Ministry of Health doesn’t know; at least they could provide water ambulances as a starting point,” she added.
The government in its Health Sector Development Plan 2015—2020, states its goal as to “accelerate movement towards universal health coverage with essential health and related services needed for promotion of healthy and productive life.”
According to the Health ministry, by 1997, only 47 per cent of the population who needed healthcare could access outpatient services and by 2016, 86 per cent of the population were within 5km of a health facility.
Stories of pain and anguish have been shared about the state of Uganda’s health sector. But what makes the state of affairs in Kalangala worse is its geographical location.
Patients, including those in the worst conditions, travel around in rickety boats and often the cost is way too high for the poor residents to afford.
According to the last national census, subsistence farming and fishing were the major sources of livelihood for dwellers in Kalangala.
One Thursday afternoon, a fortnight ago, at the windswept shores of Mazinga Island where there is a health centre III, we were told of a patient in critical condition who had been referred to Kalangala Health IV but attendants indicated it was unlikely she could be assisted to travel in such a state.
Travel time between Bukasa (the main island) and Mazinga is about three hours, and chartering a boat costs us Shs400,000.
From Mazinga, we had to connect to Bukasa, travel by road for about 30 minutes, to another landing site to get a boat to travel to Lindi Island where there is a patient in bad condition.
Travel from Bukasa to Lindi Island costs Shs120,000.
That Thursday evening at about 6pm, we set off for Lindi Island, which we were told was about 90 minutes away.
With a novice coxswain, who had bragged about having experience, and dark skies hoovering over the blustery lake, we needed a stroke of luck as raging waters tossed the boat.
We got lost thrice — the glow too dim and the directions we were given by fishermen, we found along the way led us to different islands.
We eventually located Lindi Island three hours later but the patient, 53-year-old Rose Ebong, could not travel at night owing to her condition.
The grandmother of five is yet to be expertly diagnosed to understand her condition that causes raised, red, scaly patches to appear on the skin, which a local doctor told us she has likely lived with for ages.
She has also been diagnosed with hernia and an operation has been due for the last three years but she cannot afford the medical costs.
With her condition deteriorating, the best we could do was to offer her Shs12,000 to travel to the mainland so that she could seek help the next day.
Lack of water ambulances
Ms Hellen Nakimuli, a community development officer in the islands, says the lack of water ambulances has made the situation dire.
“The situation is bad and requires urgent attention. Patients have to use boats but even getting a boat is expensive,” Ms Nakimuli said.
Mr James Banada, the medical clinical officer at Mazinga Health Centre III, told Daily Monitor that sometimes they are forced to refer patients on the basis of where they can afford to reach but not necessarily where they can get the required services.
Dr Banada said the health centre handles a monthly average of 500 patients from Mazinga Sub-county and surrounding islands.
As the boat sails out of the islands, Ms Nansasi counts herself lucky. Not even the clatter of waves that pushes against the ailing boat she is travelling in can scare her. Many of her colleagues remain shackled on the islands and others too ailing and meek to move on water.
What govt says...
The Health minister, Dr Jane Aceng, told Parliament last month that there are some 132 counties with no health facilities at all, 39 districts with no hospital and 331 sub-counties without health centre IIIs but health centre IIs that can be upgraded.
Dr Aceng further cited Kalangala among the districts that deserve special attention because of their geographical location, alongside Buvuma, Namayingo, Mayuge and Namisindwa.
However, she promised that this would only be undertaken, “when resources are available. The Ministry of Health will prioritise these districts first.”
“The estimated startup cost per hospital for construction, human resources, medicines and medical equipment is Shs31.3 billion,” she added, an indication that by all accounts, the Kalangala islanders will have to wait a little longer for the status quo to change.