Buvuma health workers eager to ride storm out

With an estimated population of 145,300 and no direct road or cross-bridge linked to the mainland in Buikwe or Mukono districts, the princely sum that the islanders of Buvuma spend on transport has made access to health and other services that much harder.

Like others, my voyage to Buvuma spanned an hour. Despite the fading of afternoon into evening, I had to cover a dozen miles to get to Kitamiiro Town Council for my lodging. Looking around Kirongo Landing Site where the boat docked in Buvuma, there were a few kiosks, fish stalls and shops. There was also a taxi park.    

Wasting no time, I hired a cyclist who ferried me at a terrific speed through a slippery, muddy, potholed untarmacked road to my destination. As a matter of fact, the motorcycle would be my preferred means of transport across the five days I spent on the island.   

Dr Barker Kanyike, the district health officer, said Buvuma District has only 12 health facilities serving 52 islands. Specifically, only nine islands—Buvuma main island, Bugaya, Namatale, Lwaaje, Nkata, Lubya, Lingira and others—benefit from the live-saving facilities. 

“The major challenges here are the high transport costs and poor transport facilities,” Dr Kanyike revealed, adding that the “lack of adequate protective gear and shortage of logistical support for the district health team” barely helps matters. 

Using small wooden boats, Dr Kanyike’s team perilously moves from different islands to dispense health services. The journey covers anywhere between six and eight hours. 

“We spend Shs300,000 to sail to the nearest island sub-county to implement health programmes and the cost to reach out to the farthest island of Lyabaana is between Shs1.2m and Shs1.5m,” Dr Kanyike disclosed. 

Facade
Buvuma Health Centre IV, the main district hospital, has a deceptive outward appearance. Once you enter its brightly painted exteriors, you will discover that it has only one medical doctor at its disposal. This is in spite of the fact that it handles maternal cases, HIV/Aids, as well as common diseases such as malaria and diarrhoea. It also carries out immunisations and performs some minor surgeries for good measure.  

According to Ms Aminah Nakiranda, the Buvuma District health secretary, 71 percent of the islanders have received one Covid-19 jab. She adds that while 25 percent have been jabbed twice, only 1.7 percent have turned up for a booster dose. 

Ms Noor Nalujja, a health official at Buvuma Health Centre IV, described the sails on small wooden boats during the Covid-19 vaccination campaign, as “not easy.” The weather, she added, turns wild anytime.

“When this happens, we loiter on water and are delayed to get to our vaccination centres. This also affects the vaccines because they expire if not administered in time,” she disclosed.

Ms Mary Gorrett Musubika, another health official at Buvuma Health Centre IV, told Saturday Monitor that they had to rent boats from fishermen to take the vaccines to the islanders. Being at the whims of the fishermen had its downside.

“The moment you schedule a day for giving Covid-19 vaccines and then fail to reach there, you will not find residents at that vaccination centre next time you plan to go there,” Musubika said. 

Mr Steven Wanda, an islander from Mayinja Village in Busamuzi Sub-county, said it would take a lot of sacrifices to get the Covid-19 jabs. 

“Generally, transport is a big issue here. I have a family of six and transporting them to receive the jab was expensive, so I only decided to go with my wife,” Mr Wanda revealed. 

Bitter VHTs
Officials of Village Health Teams (VHT) had to push the envelope to mobilise people from different villages to turn up for the vaccination exercises. The officials were promised Shs120,000 in allowances, which they haven’t received to date. 

Ms Sarah Nabirye, a VHT from Mayinja LC1 in Busamuzi Sub-county, said during the first phase of the vaccination exercise, they received Moderna and AstraZeneca jabs. These required the person to receive two doses within a specified period of time, but many who received the first jab did not return for the second. 

“District health Officials said they lacked fuel to come closer. We decided to mobilise money from residents themselves to facilitate the transportation of the vaccines and health staff from Busamuzi Health Centre III to villages and we managed to have some people vaccinated,” Ms Nabirye disclosed.

In the islands of Kkoome, the situation wasn’t any better. With an estimated population of 40,000 people scattered on 17 islands, Kkoome lacked boat ambulance services during the pandemic.

There was also no land ambulance and a reasonable fuel budget to facilitate the health teams to render life-saving services to the communities. 

Mr Lawrence Kiyingi, the LC3 chairperson, said they spent Shs240,000 on fuel to reach out to the nearest island and Shs5m to extend Covid-19 services to the furthest island close to the Tanzanian border. 

Lessons
Dr Kanyike said when pandemic curbs such as the lockdown were lifted, they convened and devised means of improving service delivery.

“We realised that there should be a clear plan and programmed referral systems from the water bodies to regional referral hospitals because at the mainland shores, there is none,” he said, adding, “We have been given a boat ambulance by the government, but there is no government land ambulance to ferry patients from Kiyindi to Mulago or Jinja. It takes about five hours to get an ambulance from Jinja or Naguru [in Kampala] and this costs lives.” 

He further revealed that they have asked “the government to provide us with the Johnson and Johnson vaccines, which are administered once.” 

A monthly token of Shs150,000 for each official on the VHT has also been floated for motivation purposes. They are yet to hear from the government, though. 

While Buvuma Local Government responded to their SOS for financial support to meet fuel costs, the Shs1 million that has been made available to the health department each year is, Dr Kanyike said, minimal.

“A single voyage to the furthest island costs Shs1.5 million in fuel,” Dr Kanyike disclosed.

Mr Emmanuel Ainebyoona, the Health ministry’s spokesperson, advised Buvuma medical staff to get in touch with district leadership to find a lasting solution to the facilitation problem.

Dr Micheal Baganizi from Uganda Expanded Programme on Immunisation, said of the estimated population of 42 million people in Uganda, 26,376,505 doses have so far been administered. The number of people who have received the first dose are 19,206,417 (44 percent) and those who have received a second jab are 6,695,557 (15 percent). The turnout for the booster dose stands at 474, 531. 

Dr Kanyike said few people completed their Covid-19 jabs on the island for a range of reasons.
“When Covid-19 broke out, we had no adequate boats to use and we had no extra fuel funds to make trips to various islands to monitor the situation or to fetch patients reported to us,” he said, adding, “The patients in critical conditions whom we managed to rescue could not reach Mulago National Referral Hospital in time because we had no land ambulance stationed at Kiyindi Landing Site in Buikwe District to forward them fast.”

About Buvuma District
Created by Act of Parliament on July 1, 2010, and carved out of Mukono District, Buvuma is found in Lake Victoria, and does not have territory on mainland Uganda. 

It is bordered by Jinja to the north, Mayuge to the east, Tanzania to the south, and Buikwe to the west and northwest. The district is made up of 52 scattered islands in the northern part of Lake Victoria. 

*This story was produced in partnership with the International Women’s Media Foundation.