It was a usual day on the ward in the rural facility I work in (kapelebyong Rural Health Center,in north eastern Uganda), as I was doing a ward round. Like other normal days it is characterised by children having malaria and usually I review them to make sure the dosages are right and they receive the right treatment.
This particular day I noticed a chicken walking through the ward and of course I was furious(given that infection control is very important) why would a chicken be moving through the ward. Then I chased it out. The African local chicken are quite fast and of course it got away.
Surprisingly after sometime I noticed the same chicken coming back to the ward. This time I asked the nurse on the ward what was wrong with the chicken.
She then revealed to me that the chicken is for one of the elderly patients on the ward. “It has even laid eggs and it must be trying to come back to lay another one”, the nurse added!!!
This made me even angrier. How can a chicken just want to lay eggs in a hospital!!!
I matched to the patient with my eyebrows up and I noticed next to her was an old sink that was not in use, with a box and about 11 eggs. The chicken had already laid 11 eggs!!! I asked her in shock, ‘’why is your chicken laying eggs in the ward?” She replied to me, I was admitted to be in hospital for 2 weeks and unfortunately I stay alone at home. This is the 3rd time my chicken is laying eggs and the 2 previous times I wasn’t home to protect it from the neighbours who stole all the eggs. I am not willing to take any chances this time so I have decided to carry the chicken to hospital with me this time, she humbly replied. I told her that unfortunately chicken are not allowed to live in the hospital next to patients because it could cause diseases and she just kept quiet. She looked at me in confusion as to why the doctor wouldn’t understand her concern.
She put me in a dilemma I couldn’t send this lady back home because we needed to monitor her meds and it was unfortunate that she stays at home alone and all her children had moved to the city, like most of the elderly women.
We ended up having to organise for her a separate empty room to be with her chicken. I am still wondering whether it was the right decision. What would you do in the same position?

   
Above you can see the eggs in the broken sink!!                 Above you can see the patient’s bed!! Next to the sink!! With the chicken seated on the eggs below!!


I am Dr. Etonu Joseph, Junior medical doctor from Uganda 29 years of age, I've been practicing for 2 years in a rural area in Uganda in a county called Kapelebyong county. I Started my work when I was 26 years old in the facility. Iam the only doctor there covering the health of 89,000 people. Being a very rural area very few doctors attempted to work there but so far i am the one who has lasted the longest in the facility..The people I serve are the humble indigenous rural people of Karamoja and also Kapelebyong county..I graduated in 2012 at the University of St. Petersburg Pavlov,the Russian Federation. But i started working in this rural area in late 2014. I ride a motorcycle to work because the roads are soo bad in the rains that sometimes it rains on me! BUT I LOVE MY WORK and I have learnt a lot from the people I serve.

By. Dr. Etonu Joseph

As a public health specialist, my work continues to improve the lives of the rural population. We utilize radio, community distributors and edutainment to health educate the masses and engage in advocacy for better health systems.

However, our efforts are still a drop in the ocean and the rural health system is faced with a number of challenges including; inadequate supply of drugs, fewer staffs, brain drainage, drug stockouts and long distances to the health centers. In addition, most specialists aren’t available in the rural areas since they aren’t well facilitated thus the population in need of their services resorts to crude methods.

I believe that good health is wealth and prevention is better than cure. This implies that as a nation, we should invest a lot in the health of our people and borrow best practices to improve our system. The health workers should not discriminate their patients or clients while offering health services to all the people.

Communities should be empowered to realize a community-owned and based healthcare insurance.

This will ensure that people don’t suffer while trying to make ends meet when desperately needing health services.

 

Written by,

Ssesanga Ernest

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Public Health Technologist in Uganda

The government sends only 30% of the total funding requirements for the health facilities leaving them struggling to meet their day to day operational needs.

There many challenges facing the rural healthcare system and these include; limited staffing that in turn leads to work overload, lack of motivation of the healthcare workers in hard to reach areas, for example, health workers sharing toilets with communities, no water sources within a walkable distance to the health facilities. In addition, constant drug stock-outs that insinuate accusations of theft from the public to the health workers.

Furthermore, there is inadequate moral support from political leaders. Most of the political leaders take in what their voters say as the gospel truth to protect their votes thus not making strides to improve the health system.

If we are to turn back the clock of our rural health system, all stakeholders including communities and political leaders must be proactive on matters pertaining their health.

There is a need for dialogue with community members, political leaders, religious leaders and clan leaders among others on the challenges facing health facilities and address the community expectations.

Empowerment of the community to become active participants and advocates for the health system they deserve. Health facility monitoring visits should also, involve the political leaders to feel part of the system and listen to the health worker’s side of the story.

 

Written by,

Ajok Betty Lanyero

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Biostatistician

The Ugandan Rural health care is dissatisfying to both the patients and the health workers. This is because the patient comes in need of a service and rarely gets it in its recommended full package. Most health care centers have health workers who are skilled but lack equipment to give that service which leads to unnecessary referrals and sometimes uncalled for deaths.

For example; I received a mother who came with a baby that had severe pneumonia. I couldn't give them the service because they were no medications available. Therefore, I had to refer this poor mother who went crying because she couldn't afford transport to another bigger hospital. I am not so sure whether that innocent child survived.

Another example is failure of a midwife to control PPH after delivering a mother due to lack of medicines to do so.  Just imagine delivering a mother under candlelight or small torchlight. So many medical errors do occur due to system problems and lead to unnecessary deaths. In a nutshell, therefore, health care workers are demotivated whereas patients are equally dissatisfied.

Other Challenges that we face are; poor infrastructure most especially in hard to rich areas, lack of enough space in most rural health centers, health workers being abused by dissatisfied patients, rude colleagues (health workers) due to work overload and burn out, poor staff remuneration in terms of salary and allowances which leads to high staff turnover.

parting remarks/ advice to stakeholders;

  • Healthcare for all can never be achieved with health worker dissatisfaction. Something must be done about staff remuneration and infrastructure.
  • There is need to provide the incentives and equipment that the health worker needs to provide any health care required by the patient. Improvement on health care setting infrastructure is essential.
  • A bottom-up approach is required for policy making by the MOH because implementers understand the system better which is why it's necessary to involve them in policymaking.
  • Need for intensified supervision which is a problem and therefore solution finding. This will reduce the laxity by health workers in these rural health centers.
  • The permanent and pensionable policy should be replaced by contract system which will make health workers more responsible at their workplace with fear of their jobs in case they messed up.
  • In-service training of healthcare workers to improve their skills since medicine is always dynamic.

 

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Senior clinical officer, Uganda

 

Working towards a world where everyone can access quality health care irrespective of their socioeconomic status or location.

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