Suffering from chronic neglect in Kaabong, Uganda

As light slowly betrays the darkness of a still night, the dying echoes of ululating women interlace with the crowing cocks that welcome the new dawn. A few hours later, Kaabong high street comes to life. A few shops emblazoned with yellow posters, remnants of a recent electoral campaign, open their doors for business. But many people here cannot afford the candles, soap or oil being sold in a handful of road side kiosks.

The people of Kaabong have the unenviable title of being amongst the poorest in Uganda.
Large parts of the population suffer from violence and chronic neglect. Seventy percent of the population here cannot access health care.

Women are particularly affected – maternal mortality rates in the area are 750 in comparison to the national average 435 per 100,000 live births - infant mortality is 105 for Karamoja as compared to 76 nationally per 1,000 live births, according to 2008 UN statistics.

Medecins Sans Frontieres’s (MSF) ambition in Kaabong is to help strengthen government health services. Teams are supporting nine Ministry of Health centers and the district referral hospital. They also run mobile clinics to isolated areas, offering medical services to the many people who cannot reach the health facilities on their own.  

But convincing people to seek medical assistance in an institutional setting is the first part of a large problem. According to the acting medical superindent of Kaabong hospital, Dr Nalibe Sheriff, getting people to walk through his hospital doors is a struggle.

“The people in Kaabong district are basically nomadic pastoralists,” he said. “They are also one of the poorest people in Uganda. So you find in the Kaabong district, the latrine coverage is two percent, and most of the people just go to the bushes to help themselves.

“Due to these conditions, diseases such as cholera and hepatitis E, they are really common here. Still, people prefer to treat themselves using traditional methods. Even the majority of pregnant women do not come to hospital to deliver.”

In fact, according to MSF 2010 data, only 29 percent of women in Kaabong deliver at the main referral hospital which is meant to cater for a population of 369,500. Talking to women about the benefits of institutional deliveries is therefore an essential part of MSF’s work here.

Kyotuhaire Merecy Ishanga, MSF’s maternal health supervisor, and her team of outreach nurses go out into the community to encourage pregnant women to come in. But as midwife Lina Loyce, who attends to pregnant women at Kaabong hospital says, many more maternal and neo natal deaths could be prevented if more women delivered in hospital:

“Mothers from here at times prefer delivering in the villages,” she said. “Like that mother there, she was brought after having pushed at home for a very long time. When we took her to theatre the uterus had already torn apart. Add to that the mother started with labor pains at 11 in the night, they reached here at 6.30, now you can imagine after all that time the baby did not survive.

Leaving Kaabong town centre over a bridge that need not be there considering that the river bed is a sandy plain where kids dig holes hoping to find water, the inhospitable surroundings span as far as the eye can see. Little more than shrubs grow out of the hard ground that cracks as it beckons the rain clouds for a few droplets of life.

Through mobile clinics, MSF attends to the hundreds who do not make it to the hospital, as Prisca Obara MSF’s mobile clinic supervisor, explains: “The reason why we started mobile clinics is because most of the health centers don’t have qualified personnel. And another issue is the distance is very far up to the health centers. Here there is raiding because these are cattle keepers. The raiders when they come from one community to another, they cross these villages so people fear that they might kill them.”

In an area where resources are extremely scarce, fighting for what little wealth there is can be brutal. Cows are people’s fortune and wealth reserve. They do not kill or eat them, except in cases of emergency. Cattle raiding has gone on for decades in the area and was initially a relatively peaceful traditional act to obtain additional fortune which was given to the families of young men’s future wives. However with the introduction of firearms around the late 1970s, the area is today the most insecure in the country.

Wounds as a result of violence adds to the plethora of medical needs in the area while at the same time, fear of being caught up in a raid keeps people afraid to travel to the nearest health facility. It also adds to the image of Kaabong as a backward place where no one wants to go, not even health staff. Kaboong it seems, has largely fallen off both the government’s and international community’s radar.

Karamoja in many ways has the highest and worst indicators in the country for many areas…for infant mortality, for neo natal mortality and for maternal mortality,” said  Will Robertson, Country Director of MSF in Uganda, “We need to address these quite systematically. It needs substantial investment by partners, to develop a health system. But in the end it’s an area that has got substantial poverty and substantial levels of violence that impact the lives, so these should be addressed in a way that improves the lives of the community. There is only so much an NGO can do so we are making a call that there should be greater investment in health services in Kaabong.”

When dusk falls on Kaabong, the kiosks put away their unsold wares, dogs meander on the dusty road side looking for a place to rest, and the ululating sounds of women singing takes hold of the night again. Like the violence, poverty, drought, and other constant hardships, there is a stable pattern to life here. A stability that masks a chronic humanitarian crisis.

In 2010 MSF teams did over 35,000 medical consultations in Kaabong district. The great majority of consultations were realized during outreach activities, especially children under 5 years old, suffering from diseases and health problems caused by indirect medical effects of insecurity, systemic neglect and marginalisation.

Médecins Sans Frontières (MSF) has provided medical and humanitarian assistance in Uganda since 1980.