Engozi enables easy access to healthcare
Members of Bukoora-Kanyankwanzi Tweyambe Group in Kabale District display the local stretchers they use to carry patients in emergency situations. PHOTO | ROBERT MUHEREZA
What you need to know:
- Kigezi sub-region’s hilly terrain makes it difficult for patients to reach health centres. Many are forced to trek long distances. Residents in Muko, Kamwezi, Kyanamira, and Maziba sub-counties often rely on traditional local stretchers to transport patients, pregnant women, and even the deceased, as Alex Ahumuza and Robert Muhereza report.
The undulating hills and terraced fields of Uganda’s southwestern Kigezi sub-region are some of the most magnificent landscapes in East Africa. Often referred to as the “Switzerland of Africa”, the same terrain has made access to health services difficult in the sub-region.
Leaders in Kigezi date this challenge back to the 1940s. At the time, some Bakiga elders developed a handmade wooden stretcher, locally called engozi to transfer patients from hard-to-reach areas to the nearest first level of medical care assistance.
Over the years, the long trek along rugged pathways, taken by those carrying stretchers on their shoulders, has claimed several lives.
John Byabagambi, a retired police officer and resident of Katookye, Kyanamira sub-county in Kabale District, is the treasurer of the Engozi Association. He says his daughter’s life was once saved when neighbours carried her on a stretcher to the nearest health centre to give birth.
“The health centre referred her to the general hospital. In this region, all we have are rugged pathways. We do not have proper roads. The engozi has been key in ensuring that pregnant women access proper delivery services in the health centres,” he says.
Byabagambi adds, however, that when it rains, the paths are impassable, further complicating the access to healthcare.
“I am requesting government officials and members of parliament to come down to the grassroots to find out the challenges that people are facing. In most cases, after they have been voted into office, they forget about the hardships we face,” he notes.
Aggrey Mbaheena, a resident of Kitumba sub-county in Kabale District, says carrying patients on a stretcher cannot be done away with because it is the only means of transporting them in emergencies.
“Our homes are inaccessible to vehicles due to the steep slopes and valleys. Carrying a patient, especially a pregnant woman, on engozi is a tiresome activity. It is worse in the rainy season because one must use more energy to manoeuver the steep hills. Four people bear the stretcher and when they get tired, another set of four takes over,” he says.
The carriers keep interchanging until they reach the main road. Here, they hire vehicles or tricycles to transport the patient to a health facility.
The groups
Mbaheena adds that if a patient is a member of an engozi group, he or she is transported free of charge. If the patient does not belong to any group, his or her caretakers pay a fee between S20,000 and Shs30,000 to be carried the long distance to the main road.
“The caregivers then pay a minimum of Shs30,000 to hire a car to transport the patient from the roadside to the health centre, although the fare may increase depending on the distance to be covered,” he adds.
The stretchers, made from bamboo and reeds, are not covered on the top so when it rains during the journey, the carriers take shelter in the nearby homestead to avoid exposing the patient to more health problems.
Fausta Kobusinge, the village health team chairperson of Omumihanga Village in Kitumba Sub-county, says carrying pregnant women who are in labour is a great inconvenience. With each step, the women are scared that the men carrying them will slip and fall down the steep slopes.
“A member of my group once told me that she was scared every time the people carrying her voiced their tiredness. When she gave birth, the nurses told her the baby was fatigued. She suspected that fatigue originated from her fears,” she says.
Robert Turyakira, an engozi maker from Buhara Sub-county, sells a stretcher at Shs280,000 or Shs300,000 depending on the customer’s desperation. He has been making the stretchers since 1991 when he took up the craft from his late father.
“There is a huge market for engozi in this region. Some of my customers come from the far corners of Kisoro District. This is my form of livelihood and through it, I take care of my family’s needs. I have seven children,” he says.
Residents carry a patient on an engozi.Due to the steep hills and valleys in the Kigezi Sub-region, engozis will remain essential as the only means to transport the sick to the main road. PHOTO | ALEX AHUMUZA
However, Turyakira’s challenge is finding the raw materials for making the engozi. Due to the degradation of wetlands in the area, some materials such as reeds are scarce.
“I have to walk long distances to look for reeds. Nowadays, I travel to Karama in Rwanda to look for bamboo and reeds. The work is backbreaking and on many occasions, after making an engozi, the neighbours use it to transport me to a health facility to get treatment,” he laments.
By travelling to Rwanda, the craftsman risks arrest. He calls on the government to support his work, which he says is “important in the community", by funding him.
Byabagambi decries that the making of the engozi is still a monopoly of a few skilled elders who have not bothered to pass on the knowledge to the next generation.
“One day that man will die with that knowledge. We do not have a craftsman in my village. The nearest expert is five kilometres away. He should teach at least three people so we are not stranded when he dies. These hills are not going anywhere and people are giving birth every day. That means we need more engozi makers,” he says.
Need for ambulances and roads
Residents call on the government to provide ambulances on the roads leading to the villages so that people do not have to spend money hiring ordinary vehicles to transport their patients to health facilities.
“Some groups located near the highway pooled together money and bought vehicles. When we arrive from the hills, carrying a patient on a stretcher, we have to negotiate with these groups to transport the patient to the next stage. If there were ambulances, we would not have to pay that added cost,” says Polycarp Sunday, the chairman of Rugarama Kweyamba Engozi Group.
The group has 150 households in Rubira Village. They have one engozi, which all members have access to. They also hire it out to people who are not members of their group.
“Sometimes, after walking a long distance, we find the health centre closed. This is disheartening. How can health workers lock up a health centre yet receive salaries from the government?” Sunday asks.
David Muhereza Kato, the LCIII chairman for Kitumba sub-county, who is a member of Kijurera Engozi Group, expresses the need for the government to increase funding towards the establishment of community access roads to reduce the risks involved in carrying patients on local stretchers over a long distance.
“I am sure that once community roads are constructed, the burden of people carrying patients in local stretchers for long distances will reduce although the use of these local stretchers will always remain key in handling emergency cases,” he says.
Patients who die in health facilities and have to be transported back to their villages in the hills are also carried on stretchers. On average, about 50 patients are transported from each parish.
Health actors speak out
Dr Gilbert Mateeka, Kabale District’s health officer, explains that district ambulances are always on standby to transport referred patients from the lower tier health facilities to the referral hospital.
“The district has four health centre IVs, 14 health centre IIIs, and 22 health centre IIs equipped with health workers and the required equipment. However, the stretchers are important in helping people access the health centre IIs,” he says.
Dr Mateeka advises people to observe healthy lifestyles to avoid contracting disease since, according to him, 75 percent of the disease burden in Uganda is preventable.
“We appeal to them to take their health into their hands. They should also embrace other interventions to prevent communicable diseases. For instance, it is discouraging to note that we continue to get new HIV infections every day despite the messages we have put out. As we say, prevention is cheaper than cure,” he says.
Obed Mutatina Kitabutuka, the secretary for social services in Rubanda District Council, says using engozi is not an indicator of backwardness. It is a historical innovation in the face of terrain challenges.
“In the rural areas, it is common for mothers in labour to be carried on stretchers at night. To mitigate any complications that may arise, we always advise pregnant women to check into health facilities two weeks before their expected date of birth,” Mutatina says.
Rubanda District has two health centre IVs, seven health centre IIIs, and 20 health centre IIs.
Due to the steep hills and valleys in the Kigezi Sub-region, engozis will remain essential, as not all homes are accessible by vehicles.
Produced by Nation Media Group in partnership with the Bill & Melinda Gates Foundation
General Manager Editorial Daniel Kalinaki, Acting Managing Editor Allan Chekwech
Editor, Sustainability Hub Gillian Nantume, Features Editor Caesar Karuhanga Abangirah, Contributor Alex Ahumuza and Robert Muhereza
