We had a drop-off one of the first days in Gulu, and my group’s assignment was to investigate the health care in Gulu. Our last stop, after a hole-in-the-wall laboratory services clinic, small but clean Universal Medical Center, and pharmacy, was the Gulu Regional Referral Hospital.
We walked down the dirt road, past women selling cassava and bananas, through a gate, and into the hospital compound. Past children’s cries to the right, emanating from the Children’s Center and Women’s Center, and a sign to the left: Gulu and Italian Partners in Health, or something to that effect. We turned left, into what we correctly assumed was the main wing. Stepping through the front door and two steps further, we were in the center of the hospital – no waiting room or reception desk, no one to welcome us or tell us where to go. A small bench signified that where we stood was the entryway, a door straight in front of it, maybe 5 yards away, leading outside.
The building was one long hallway with beds on either side. Men and women filled every bed and the spaces between them, lying on mats on the floor. The windows were open, ventilating the sticky heat of the room, and flies buzzed around patients’ heads. A group of black and brown and white people, clad in white lab coats, stood in a circle discussing something. They looked worried, except for a cheery nurse who left the clump to attend to a patient. She told us to wait a moment, she would get someone to talk to us.
I couldn’t help but look at the person’s dry, cracked feet right in front of me – the blanket wasn’t long enough to cover them. The person waved a fly away and caught my eye. I looked away, but someone was calling us anyway.
We were shuffled to the central office, where we spoke to the Medical Superintendent. This is what he told us:
Gulu R.R. is high on the hospital food chain. It is one of 15 regional referral hospitals funded by the government, and the only higher level is national referral, of which there are two in Uganda. One is in Kampala, the other in Mbarara (I think).
The government provides 80% of the hospital’s supplies, which are sent from a national pool system. Services are free.
The hospital serves the North, from Gulu to Kitgum to Pader – a total of around 2.5 million people, and the hospital is designed to hold 250 beds. 400 beds line the hallways now, but the number of patients is near twice that. They operate on 78% of the staff they need, with only 17 doctors. He sad that attracting doctors here was difficult because the Ugandan salaries for medical doctors are low, especially in the North; many med school students go to other regions, if not other countries, to practice.
70-80% of patients come in with malaria, and the second most common disease they see is AIDS.
I’ve heard of the stories; I’ve seen the statistics of malaria in sub-Saharan Africa, the child mortality rates. A few people on the program have gotten malaria, but it seemed like nothing – a simple doctor’s visit, decidedly NOT to Gulu Regional Referral, some medicines, bad flu-like symptoms, then it’s over. But when my homestay sister Belita got sick with malaria, I learned what those statistics actually meant.
Belita is almost two years old, and she has had malaria three times, twice since I moved in with her family. When I first came, this little girl was a bundle of energy, and surprisingly consistently happy for a girl close to the Terrible Twos. But she got a cold at first, or that’s what we thought, and became a perpetually fussy toddler. Mama gave her cold medicine, wiped her little button nose, and put her to bed.
But giving her cold medicine is no easy feat – Belita is a fighter. She starts crying as soon as Mama sits on the floor and calls her over, before she even sees the brown bottle. She kicks and screams so much, Mama has to pin her little legs between her own and her arms to her sides. Belita throws her head back, sobbing and trying her best to escape, and Mama holds her nose and pours the stuff into the little mouth, forcing her to swallow. Little Belita gets so mad, she walks to the nearest person, usually me, and climbs onto his/her lap with tears running down her cheeks and an injured look on her face. If she doesn’t throw up the majority of the drugs, which is the usual case, she falls asleep instantly.
But after the medicine episode and going to bed, she seemed better the next morning, and the next. But by nightfall she would fall asleep in my arms, sweat pouring down her chubby little cheeks. Mom took her to the doctor, who diagnosed her with level 1 malaria (still no idea what the levels mean).
We got some more medicine from the clinic near our house, and continued the twice-daily torture of administering it to her. But she never really got better; in the morning she’d be fine, but still, every night, she’d sweat and refuse to eat. Her little limbs started losing their chubbiness and her sleeping habits completely changed, and she was constantly on the edge of tears, all within a week.
So Mama took her to the doctor again, more worried this time, and came back with the news: level 3+ malaria. They gave her a shot at the hospital to start fighting the disease. Apparently, if Belita didn’t improve in two days, she’d have to go back to the hospital and be put on a drip.
Listless and quiet before, Belita would scream and holler her loudest as soon as she knew medicine was coming. But this time, the doctor told us to keep giving her more if she threw it up – she HAD to get enough in her system. Belita would vomit, still crying, grape purple spit hanging from her pouting lip, and Mama would hold her nose again until she opened her mouth for more medicine.
It was awful, and I felt almost worse for my mom, who never got a break from this duty. Even when Dad was home and had Belita on his lap, he’d just hand her over when the bad-guy part came and wait for his good-guy moment when Belita would come to him for comfort. And I would hold her legs or pinch her nose, but Mama still had to deal with it the most.
Mama was sick too, and pregnant – I don’t understand how she does everything she does, and with a baby on the way and the flu, too! I tried to help around the house, but she really only let me go to the market for her.
Belita fell in and out of sleep on the couch for almost two days. She wouldn’t eat unless Mama threatened to give her medicine before every single bite.
I couldn’t stop thinking about what my mom had told me when I refused to take my billionth serving of posho, “People will think you want to die if you don’t eat!” And I couldn’t stop thinking about that insurance policy that people here have – they have as many children as possible because they expect to lose two or three. It sounds so dramatic, but I was terrified, and it made me homesick for the first time since I’ve been here.
Finally she had enough energy to go outside and play for a few minutes; then she started eating more. When Dad came home from his weekend at school, she instantly brightened. The next day I left for Kampala.
I’m living in a hotel for the month of our independent research, so I went home yesterday to visit my family. Belita greeted me, playing outside in her underwear, and giggled incessantly when I picked her up and tickled her. She was chubby again! I can’t even express how happy I was to see her back to her lively, happy self.
I finally understand this culture’s approval of “fat” people. If you’re too thin here, you’re sick. Most likely with malaria or AIDS… my mom was so happy to tell me I was getting fatter and no longer looked like an AIDS victim. Oh, Uganda! SO different from the States.
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