Lochoro: The lone midwife delivering Ik’s babies
Anna Grace Lochoro a midwife Timu Health Centre II.
What you need to know:
The Ik people, often portrayed as one of Uganda’s most neglected and isolated communities, have endured decades of marginalisation. Poor roads, limited infrastructure, and political neglect have left them cut off from many of the services taken for granted in other parts of the country. Timu Health Centre II has only two staff catering for a catchment area as wide as 12 kilometres, as Barbara Nalweyiso reports.
In the rugged, wind-beaten hills of Kaabong District, nestled in Timu sub-county, stands Timu Health Centre II, a modest government health facility that, on paper, should be staffed by at least two medical workers, a cleaner, and assisted by village health teams (VHTs). Yet, on the ground, the daily reality is starkly different. Here, one woman’s unwavering commitment keeps the facility alive. Anna Grace Lochoro, an enrolled midwife, carries the burdens of not only her designated duties but also the many tasks that have been abandoned by others.
This is all in the service of the Ik, often described as Uganda’s most forgotten community. When we arrive at the health center, we find Lochoro already hard at work. Quietly, she walks through the facility - eyes sharp despite the fatigue lining her face - inspecting the rooms where she had spent the night. Without hesitation, she picks up a scrubbing brush and goes to work on the dusty floors. Under government staffing rules, this is a task that should have been performed by a cleaner.
“I always start early in the morning. I check how I left things the day before and make sure everything is in place. When there is no cleaner - which happens more often than not - I clean the health facility myself,” Lochoro explains, pausing briefly to brush sweat off her forehead. While such voluntary efforts might be seen as exceptional in many parts of the country, for Lochoro, they have become a routine necessity.
The designated cleaner of the health center, she tells Daily Monitor, frequently misses work during the planting season, prioritising farm work over her official duties. Yet cleaning, while physically tiring, is only the beginning of the day’s demands. The night before, Lochoro had stayed up late with Mercy Akello, a labouring mother, who arrived at the facility after leaking amniotic fluid for nearly a day.
Akello traveled from Tul Tul Village to the health centre, a distance of 12 kilometres, on a bodaboda at a cost of Shs5,000. Her husband did not accompany her. “I always give birth in a health facility because of the care I receive. If you deliver at home, you can over bleed yet there is no medicine to stop the bleeding. Some women deliver at home because they lack transportation to the health facility,” says the mother of three. Lochoro monitored her closely through the long, dark hours until 1:30 a.m. when she delivered a healthy baby girl, weighing 2.4 kilograms. “I only got to rest around 2 a.m. Sometimes, when you are the only one here, you do not have the luxury of stepping away,” Lochoro says quietly, the exhaustion evident in her eyes.
Mercy Akello, a new mother. PHOTO BY BARBARA NALWEYISO
Structural challenges
Officially, Timu Health Centre II should have two medical staff - an enrolled nurse, who is the facility’s in-charge, and Lochoro, the midwife. The volunteer who once helped out recently left to attend job interviews, and the nurse is frequently absent. This leaves Lochoro to manage everything alone, from consultations, deliveries, record-keeping, and drug administration, to minor diagnostic testing. “On average, I attend to over 20 patients, several of them from pastoralist families such as the Turkana who trek long distances over rocky terrain.
Some mothers start labour far away and by the time they reach us, they are already delivering. Sometimes, they give birth on the road,” the midwife recounts. As a Level II facility, technically, Timu Health Centre II should be able to handle minor illnesses, uncomplicated deliveries, and basic testing for malaria and HIV.
For anything beyond its capacity such as complicated pregnancies, surgeries, or severe infections, patients must be referred, often to Kamion Health Centre III, located over 30 kilometers away, or to Kaabong Hospital. The referral system, though, usually fails to deliver timely help. “We do not have a laboratory but we improvise. We also lack advanced drugs. If a mother cannot push the baby or if she is bleeding too much, I have to refer her.
However, calling for an ambulance is a struggle,” Lochoro says. In this isolated corner of the country, mobile network coverage is so poor that to make a phone call, the midwife must leave the health center and walk to a specific spot with a flickering signal. The ambulances often take hours or days to arrive, navigating roads that become nearly impassable during the rainy season.
The stronger signal in the area is from Safaricom, a Kenyan mobile network operator. The Member of Parliament says three masts and three boosters had been earmarked for the region. However, they are yet to be seen. “One time, a mother had a contracted pelvis and I had to refer her. The ambulance did not respond in time but luckily, we did not lose her,” Lochoro says. Such cases are not isolated.
Anna Grace Lochoro, an enrolled midwife at Timu Health Centre II, cleaning the facility. PHOTO BY BARBARA NALWEYISO
Hillary Lokwang, the area Member of Parliament recounts the recent death of a two-year-old child whose mother waited two days for an ambulance that never arrived. “How do you explain this kind of situation to a grieving mother? The Ministry of Health (MoH) gave ambulance to Ik County but because we do not have a health centre IV, the district retained the ambulance for the general hospital. Our county is 50 kilometres away from the district headquarters,” he explains.
The legislator adds that Shs714 million had been set aside to elevate Timu Health Centre II. Unfortunately, the plans were scrapped. “The MOH guidelines say that even if a facility does not have a fence, the ambulance can be parked at the police post. But that is not the case here. Luckily, I have a personal ambulance which transports patients free of charge,” he says. Another challenge is that several pregnant women, like Akello, come to the health facility without attendants.
Lochoro ends up providing both medical care and caretaking services. “I should have left the health facility yesterday, but bodabodas are scarce in this place. I have to remain here until one passes by. Since I gave birth, the midwife has been taking care of me. She cooks food and tea and feeds me,” Akello says.
Government response
Dr Sharif Nalibe, the district health officer, admits that health workers like Lochoro are severely strained. Sometimes, they are forced to close the health facilities where there is no one to attend to the patients. “Currently, our staffing levels are at 24.5 percent, which is way below the national target. We have been suffering with the issues of low human resource for a long time yet the government expects us to perform like all other districts which have a staffing level of more than 70 percent,” he says.
Anna Grace Lochoro, a midwife at Timu Health Centre II checking on a mother and a baby she helped to deliver
The district has a severe shortage of doctors, laboratory personnel, midwives, nurses, and anesthetic officers. The roads are poorly maintained and the few ambulances encounter challenges. “Recently, we referred a patient to Moroto Regional Referral Hospital. The ambulance used a shortcut, which was in a much better state than the main road.
However, on his return, the driver encountered marram in the middle of the road and the ambulance overturned,” Dr Nalibe says. The poor roads are causing delays in referrals and also lead to high maintenance costs for the vehicle. Kaabong district has one general hospital, eight health centre IIIs and 21 health centre IIs. Members of the VHTs, trained to offer basic healthcare services and outreach are not stepping in to lighten the burden.
The answer lies in systemic neglect. “Whenever we ask them for help, they say, ‘We do the work, but there is no appreciation or facilitation.’ Without them, we are overwhelmed. Luckily, I have never lost a mother. Every time I wait for help, I pray. By God’s grace, we make it through,” Lochoro says. Her words carry the weariness of someone who has spent years carrying the burdens of an entire health system on her back. Yet, they also carry a stubborn hope that refuses to die, even when the odds are stacked high. But how long can individual heroism compensate for systemic failure?
