The mere mention of the word tends to raise the political hackles and typically would begin a debate between those fear-mongering about an Armageddon of socialism ripping away personal choice and quality and those believing that an impossible utopia of high quality healthcare can and should be freely available to all. I've no desire to enter that debate because like all political debates they are so rarely fruitful or uplifting. Rather, as I am leaving Uganda, I am reflecting upon my experience of having seen healthcare here, and it brings me home not armed for debate, but armed (or disarmed) with two things: gratefulness and shame. I don't really have much commentary about what I have seen at least with regards to any notion of solutions or of what SHOULD happen to fix things. The ONLY thing that I can piece together in my head at the moment is that I ( not “rich” people, not people with more time on their hands, and certainly NOT the US government – I cannot vote my way into fulfilling the command to “love my neighbor”)...I need to change and I need to do something – the theme that keeps playing in my head. I suspect it might be the Holy Spirit.
There is a time and a need to look for solutions to both our own healthcare issues and the rest of the world’s healthcare issues – which I can assure you, the majority of which are FAR worse than our own. So much so, that at this moment I feel ashamed to think about what we take to be our healthcare problems. This is a gut-level reaction, because like many things in Uganda, seeing the quality and availability of healthcare here will hit you HARD in the gut. I don't think I can write or show pictures well enough or extensively enough to make my point - though I will try. One MUST experience it for it to have its full effect. As anyone will tell you who has been to a missions trip or something akin to it in a third world country, you can coach, train, and educate all you like beforehand, but once the boots are on the ground then all bets are off. Now you see, feel, smell, and taste...imagination is no longer required and some will find it unbearable - especially so when you see what is to be seen in healthcare.
Even the poorest of US health clinics or hospitals cannot come anywhere near comparing to what I have seen. If they did, they would be shut down immediately. I kept thinking about times in the US when I have heard patients requesting private hospital rooms as I see the crowded wards around here – patients often on floors for lack of beds (beds were mostly ancient, by the way and I saw more than one patient without a mattress of any kind. More to the point, while I observed some surgeries and wandered about the various wards of Mulago Hospital and the UCI, I kept asking myself to imagine what I would feel if one of my kids were a patient here. It is VERY hard to fathom being able to bear it...I'm ashamed to admit. Because, how can I call these people my friends (which I do) and yet say to myself: “Goodness, I’d NEVER allow my child to be treated here, it’s deplorable. Sub-par. Dirty. Old equipment. Gross. Unsafe. Cracked and dirty walls. Broken windows. Lights not working. Exposed wiring. Is that mold? Bugs. Shabby construction. Over-crowded. Loud. Screaming children with impossibly large tumors deforming their faces. Repairs done with cardboard and duct tape, Nurse to patient ratios: God only knows.” And yet, I’d know, for my Ugandan friends their children have no other options. And really, for many of them such an experience isn't MUCH different than their daily lives at home, which for a family my size might well be a single room shanty with nothing but mats on the floor for beds. It’s the sort of stuff that one can imagine Sally Struthers wandering through making appeals on behalf of the people around her...amidst the mire of poverty.
Many of us know the happiness of coming home to comfort after being out camping for a while...for most Ugandans, there is no “going home” because they are “roughing it” everyday at home. I suppose this is why they really don't recoil at the sight of things in the hospital like I do. Some areas of the hospital look more like scenes from a zombie apocalypse movie rather than a functioning hospital. And I must say I was a little taken aback by the quality of sterility that was being maintained which was wholly behavioral and had nothing whatsoever to do with lack of money. I'm still processing that little concern – is it ignorance (I don't think so), is it apathy (perhaps), or is it a generally lower level of expectations? Whatever the reasons, it certainly added to what would be my apprehension of having my kids be treated here – probably a much bigger concern than the general discomfort a rich man (like me) experiences when being amidst a profoundly resource poor environment and not having an immediate escape route.
The Project House is always our escape. It is a akin to the sort of place the superwealthy of Uganda live, and there we can kick off our shoes, sit on the veranda in comfort and ease and marvel at all we've seen and witnessed. One colleague who was in a different surgical theatre than I, told me as we reflected on the day's experiences, that she had to leave the place because the whole wing reeked of feces, urine, and blood. It was overwhelming she said.
|This is the main entrance to the surgical theaters where staff obtain
their scrubs, change and then enter the doorway in the picture to go to
the room where the patient will be arriving shortly. |
|One of the many transport beds for patients. I've seen them look worse than this by far.|
|An examine Room|
|A ward at the cancer institute - soon to be in use.|
The last two pictures were from my first series of trips - the crowds were too much to take more pictures at Mulago. As I've said before, I do not like to photograph people without permission and so avoided doing so - not to mention how bad would I look snapping pictures in a place full of sick people....REALLY sick people.
...offered by Dn. James Ferrenberg, a sinner at 11:37 AM [+]
Near the last day of my most recent trip, I noticed an elderly man who was obviously in very bad shape, propped up against a younger man who I took to be his son. They were sitting in the dirt out in front of our main clinic offices, as do many people - although some are lucky enough to have a mat, a blanket or some cardboard. The younger man was embracing his elder and was allowing him to lean fully against him...almost as if in his lap. He spoke to him in Lugandan, but the man did not respond - he was not doing well. As he shifted some, the younger man gingerly covered the older man with a blanket so as to give him some privacy because he had a urinary catheter in place and his pants were unbuttoned. As with many other patients who could be seen lying about, he also had an IV line setup, but was receiving no drugs at the moment...no pain killers...no fluids. And they sat on the ground in the hot sun amidst the dirt.
I was told the old man was terminal and nothing could be done for him. There were no beds available for him in which to die with some relative comfort as many of us would expect to see when such a scene is enacted in America. No, he died on the red Ugandan dirt, held up and embraced in his son's arms. Not a few times are the roles reversed and parents hold their children as they die here...of what in America would have been a largely curable cancer. This hard fact gut punches you: your child is far more likely to die here than the same child were he or she born in America. More parents weep here than at home.
Now, what have I got to complain about today....hmmm...