34 NEW VISION, Monday, May 2, 2016

HEALTH & BEAUTY

Bad roads affecting ambulance system

Ugandas health care
system is grappling with
many ambulances grounded
due to minor and serious
mechanical conditions. Even
those that are functioning
are not providing high
quality services . In some
areas, transferring patients
to referral hospitals is not
easy. In a three-part series,
Andrew Masinde explores
the state of the ambulance
service in rural areas

ransferring patients to referral

hospitals is not easy in rural
areas. The roads are bad and
many people have ended up
losing their loved ones because they
failed to reach the referral hospitals.
Indeed this is backed by statistics
for instance, for the case of maternal
mortality.
According to the 2011 Uganda
Demographic Health Survey report,
maternal mortality rate was found to
be 438 per 100,000 live births.
After being told by one of the
residents of Bukwo district in eastern
Uganda, that if a patient is referred
to Kapchorwa Hospital during the
rainy season, it is better to return
home than to waste time travelling, I
decided to prove it myself.
On a chilly Thursday morning, I set
off to Bukwo.
The journey from Soroti to
Kapchorwa via Mbale was smooth,
giving an impression that the whole
journey would be smooth.
However, upon reaching
Kapchorwa town, I was told the road
was bad. As I was looking for a taxi,
a bodaboda rider told me that pickup
trucks and lorries are the main
means of transport and that the fare
is high because of the bad road.
The fare is between sh25,000
and sh30,000 to Bukwo, yet it is
just 77km and the journey takes
six to eight hours, the cyclist said.
It is estimated that the fare from
Kapchorwa to Bukwo would be
sh7,000 and the journey would take
45 minutes if the road was good.
I moved to a heavy duty Nissan
pick-up truck on which 23 of us
were loaded like sacks of charcoal.
The truck also had carrots and
Irish potatoes, which belonged to
a few traders who were part of the
passengers. After setting off, we
travelled for two kilometres, before
reaching a murram road. One of
the passengers alerted me that hell
had started and that I should brace
myself.
The road is full of bumps, slopes,
hills and rocks. The corners are very
sharp and narrow, yet the driver was
reckless. Other passengers seemed
not to mind the speed People seemed
comfortable with the speed, yet my
heart was threatening to leap from
my chest. The driver was negotiating
corners and cliffs and at some point
I was afraid the vehicle would
overturn. Thank God we reached
Bukwo town safely.
Early in the morning, the following
day, I decided to visit Bukwo Health
Centre IV for an interview with
the in-charge, but I did not find
him. I decided to travel back lest I
would miss the second vehicle to
Kapchorwa. There are a few vehicles
that ply that route. Upon boarding

A truck gets stuck on one of the roads in Bukwo. The bad roads cannot allow ambulances to drive
through hence making it difficult for patients that need emergency care to get medical attention
the truck, we travelled for about
20km and then the heavens opened
up.
Though the road became slippery,
the driver assured us that we would
reach Kapchorwa safely. However,
the further we went, the worse the
road became, until the vehicle could
not handle anymore. It rained heavily
for over six hours, and thereafter
it drizzled the rest of the day. He
decided to park the vehicle after it
failed to move on the slippery road.
And when the rain stopped, we had
to push the vehicle such that we
could get away from the slippery
areas and wait for the road to dry.
After three hours, the road dried a
little bit, so we pushed the vehicle
back on the road and resumed the
journey. We travelled for 11km and
the driver lost control and swerved
off into the trench. We all got off and
started pushing in vain.
We left the vehicle behind and
walked to the trading centre for a
distance of about 11km. At the time,
it was coming to 4:00pm. We were
lucky this time the driver negotiated
the muddy road until we reached

Kapchorwa.
Indeed, this was a true reflection
of what would happen if there was
an emergency case. Imagine if the
patients only time for survival was
four hours, but here you spend 11
hours on a 77km-road from Bukwo
to Kapchorwa.
Northern Uganda
After that experience, I headed
to Lira to compare notes with
Kapchorwa Lira. This side was worse
than the route to Soroti. The road

Ambulance use in karamoja

After Bukwo, I decided to get an
experience of accessing referral
hospitals when in Karamoja. I
started on a journey to Abim district,
which is 132km from Soroti. The
road is full of bumps and mounds
and it felt like I was travelling in a
sweet potato garden.
The dust rises and by the time you
reach Abim it is like you are from a
construction site.
However, the journey was not that
long, because the road was dry, and
after three hours I was in Abim.
Early in the morning, I visited Abim
Hospital, where I interviewed the
hospital administrator about the
challenges faced after patients are
referred.
Bradford Okori, the Abim Hospital
administrator, says the hospital

serves a population of 95,610 in the

district and 17 lower level health
care facilities (health centre IIs and
IIIs) and neighbouring districts in
Lango and Karamoja region.
He says accessing the main
referrals is too costly. The hospital
had six ambulances, but all had
broken down because of the bad
roads, so taking a patients to Soroti
or Lira takes about four hours, yet
the journey could be 45 minutes if
the road was good.
Four years ago, we decided to
stop collecting patients from health
centres and also from their homes
because accessing them is very
difficult. This partly is what causes
the ambulances to break down
because the terrain is bad and the
roads are too slippery, he explains.

Sometimes,
the patients are
asked to fuel
the ambulance
because the fuel the
hospital receives is
not enough.
Byenume

was flooded at some points, and it

also becomes muddy during the
rainy seasons. In some cases, the
vehicle swerved off the road, but
thanks to the drivers experience we
did not have to push the vehicle like
in Bukwo.
The journey took four long hours.
Indeed, if the ambulance had to
make a return journey, it would have
to spend most of the time in a garage.
Hoima
On my fifth day, I travelled to the
western part of Uganda and my
destination was Hoima district. It
was a smooth ride from Kampala to
Hoima as that road is tarmacked.
Thereafter, I decided to visit Kabwoya
Health Centre IV, which is 45km
from Hoima town. In this part of the
country, public transport involves
saloon cars, not minibuses. Since
the car was small, the operators had
to pack in as many passengers as
possible.
For 45km, we were charged
sh7,000 each. The passengers were
packed like beans and had no
breathing room.
At the health centre, I found one
nurse, Saidat Babirye, attending to
patients. She gave me 10 minutes.
She said Kabwoya Health Centre
gets sometimes three to four cases of
patients who need referrals and most
times they are expectant mothers.

She said on several occasions, they

would refer patients to Hoima referral
hospital, but after a few days, they
would receive calls that the patients
had passed on because they could
not get transport to Hoima Hospital.
The Government needs to work
on the roads because if people are
to access referrals, then the roads
should be good in order for the
ambulances to move fast, she said.
While we were still talking, it
started to rain heavily. I went to the
stage hoping to get a taxi. However,
all the taxi drivers were not willing to
travel as they had heard that the road
was slippery.
I negotiated with the driver and
we agreed on a fee. The first few
kilometres were not bad because
the road was not slippery. However,
11km to Hoima town, things took
a turn for the worse. The road was
muddy and slippery. The driver
began complaining, but I offered to
push the vehicle until we got to a
better place.
We tried our best until we reached
Hoima and I was asked to pay an
extra fee, which I gladly did because
of the hurdles I had seen him suffer.
I just imagined what would have
happened to me if I was a patient in
need of urgent treatment. Would I
have pushed the vehicle?
Francis Kahwa, a resident of
Bitamba village in Bwijanga subcounty in Masindi district, said bad
roads almost cost his brothers life. It
was at 3:00pm when he received a
call from a friend that his brother had
been involved in an accident.
I rushed there and he was critically
injured. I took him to the health
centre from where he was referred
to Mulago Hospital in Kampala for a
knee operation. I looked for means
of transport in vain. Later, we were
lucky that we got a taxi. However,
the driver told us to let other people
squeeze in, but it was risky for the
patient to travel this way, he said.
He added that they could not travel
in that taxi, so they decided to use
a bodaboda to Hoima town, from
where he got transport to Kampala.
The district health inspector
of Hoima, Fredrick Byenume,
said Hoima referrals face many
challenges that include lack of
enough ambulances in the hospital
and health centres. If you are lucky
and the only ambulance at the main
hospital is there, then sometimes you
may not survive to buy fuel because
the little they get is also used for a
generator, which at times works 24
hours because of frequent power
shortages.
The hospital has only one
ambulance that was given to them
after the Commonwealth summit
in 2007. Because of the frequent
movement of the ambulance, the fuel
is not enough, so patients have to
foot the bills, which at times delays
the referrals. They pay for fuel only
when they have an emergency that
needs referral and it depends on the
distance of the referral and many
cannot afford it.
In urban centres, all the public
ambulances are free-of-charge.
In tomorrows New Vision, find
the second part of the series
which reveals the percentage of
the ambulances grounded. This
story was supported by African
Centre for Media Excellence
(ACME).