A boost for women’s health in Uganda

Mulago Hospital, Kampala

Jake Lyell

For many years, the women’s oncology ward in Mulago Hospital in Kampala, Uganda, was overcrowded and under-resourced. With few beds and nowhere for patients to stay, women would lie on floors and in corridors, often in immense pain, waiting for the sole radiotherapy unit which services the whole of Uganda – a country of over 33 million people.

‘It’s one thing to see poor conditions in rural villages,’ recalls Dr Anthony Silverstone, a consultant from University College London (UCL) who visited Mulago in 2005, ‘but here, in the main hospital in the capital of Uganda, there were women lying in corners in acute distress, just accepting what was happening to them.’

Seven years on, conditions at Mulago Hospital have improved. While the same radiotherapy unit is still in use, oversubscribed and literally held together with sticky tape, those undergoing treatment can stay in the Mulago Radiotherapy Patients’ Hostel, which provides comfortable and clean accommodation close to the hospital.

According to Christine Namale, who received treatment at Mulago in 2010, ‘the hostel beds have mattresses, there is plenty of water and there are places to sit and cook… life would be very difficult without the hostel.’ Fellow patient Sarah Mwesigwa agrees: ‘The team really know what they are doing – and the conditions are much better than before.’

‘The last five years have begun to change the way women are viewed in Uganda. There is now a greater sense of urgency in terms of access to healthcare’

These developments are just some of the achievements of the Uganda Women’s Health Initiative (UWHI), a collaborative programme between Britain and Uganda involving Mulago Hospital, Makerere University, Hospice Africa Uganda, the Institute for Women’s Health at UCL and the Ugandan Ministry of Health. Set up in 2006, UWHI came into being after its founder, Professor Ian Jacobs, now Dean and Head of the School of Medicine at the University of Manchester, became aware of the multiple health challenges and care inequalities experienced by Ugandan women.

‘The scale of the problem was, and remains, enormous,’ explains Jacobs. Due to lack of screening and treatment facilities and poor health education, of the 3,577 women diagnosed with cervical cancer each year in Uganda, 2,464 die from the disease – a death rate of 35 per 100,000 (compared to two per 100,000 in Britain). In fact, cervical cancer is the largest cause of death from cancer among women in Uganda.

Unable to walk away from the situation, Professor Jacobs and his colleagues decided something had to be done. ‘If we could save one life, and do no harm,’ says Jacobs, ‘[we took the view that] it would be worthwhile.’

Mobilizing women

And so it has proved. Recently celebrating its first five years of operation, the UWHI has implemented a range of projects aimed at improving the health and quality of life of the women of Uganda. Through the introduction of simple screening techniques and new centres in Kampala, for example, 11,130 women have now benefited from screening for the first time. The UWHI medical teams have prevented nearly 440 cases of cervical cancer and diagnosed 62 cases before they could become more advanced.

Nurse Annet Nabakka counsels Veronica Aguti at Central Kampala City Council Dispensary.

Jake Lyell

UWHI has also carried out invaluable research into the prevention of postpartum haemorrhage (PPH) in rural settings. Due to the limited availability of oxytocic drugs (which are injected immediately after childbirth), PPH is the number one cause of maternal mortality in the country. In an attempt to address this problem, UWHI has assessed the feasibility and effectiveness of a distribution programme for misoprostol – self-administered tablets which operate in the same way as oxytocin and which now, thanks in part to UWHI, have been licensed for use in Uganda.

In other areas, UWHI has pioneered the use of ‘brain cooling’ techniques to prevent or reduce brain damage in new-born babies, and provided vital hospital equipment, training and infrastructure. But above all, says Gertrude Nakigudde, a patient advocate and counsellor, the programme has helped to tackle the stigma surrounding cancer and mobilized women to act: ‘UWHI has encouraged women to seek treatment; it has raised their awareness and empowered them to seek help and take control of their lives.’

It’s a view echoed by Sarah Mwesigwa, who believes that ‘the last five years have begun to change the way women are viewed in Uganda. There is now a greater sense of urgency in terms of access to healthcare.’

Many challenges remain, however. Under-funding, limited space and lack of resources are still major concerns as Professor Jacobs and his team plan the next five years of programme activity. The aim is to roll out projects nationally across 80 centres. If screening could be extended to 400,000 women a year, says Jacobs, the lives of 40,000 women could be saved. Cultural barriers also remain firmly intact. Dr Anne Merriman, founder of Hospice Africa Uganda confirms that ‘when it comes to healthcare, women are second-class citizens here in Uganda. Men are often reluctant to pay for treatment for women who are sick. Even if a woman holds a position in government or the civil service, often when they get back home or to their local community they are treated as inferior by their men.’

So, while much has been achieved, much also remains to be done. But with powerful figures in Uganda now firmly behind the project, including First Lady Janet K Museveni, there is hope and expectation that it can succeed on a wider scale and continue to fulfil its mission – which, in the words of Professor Jacobs, is to ‘reduce suffering, empower women, and save the lives of some of the most vulnerable people in the world’.

Jack Craze is a freelance writer and journalist specializing in development and sustainability.

To find out more about the work of UWHI, its programme objectives and fundraising needs, go to uwhi.org

The race to beat the West Africa food crisis

Emilio Labrador under a CC Licence

In the town of Ségou in south-central Mali, Salif Kanté is grappling with the increased costs of basic cereals. ‘I recently purchased my family’s food stock for 2012. I spent almost twice as much as I did last year for the same quantity,’ says Kanté, a worker at the Malian agricultural NGO PRECAD. He knows he is better off than most: ‘Many people are struggling here.’

Throughout Mali and the Sahel, cereal shortages and rising prices are hitting households hard. Following drought and poor harvests in 2011, Mali has seen crops reduce by a quarter and a 50-60 per cent leap in food prices above the five-year average. Many have had to sell their livestock and reduce their daily meals, leaving some three million at risk of chronic malnutrition.

‘Food prices in the Sahel are particularly high for this time of year,’ confirms Julien Jacob, Action Against Hunger’s head of food security. In Mali, he says, ‘100 kilograms of millet meal currently costs around 22,000 CFA [$44], which is already a higher price that you’d expect in July. Poor families in Mali have an average monthly income of between 50-65,000 CFA ($100-150) so it’s clear that current prices – which could rise still – would leave them with almost nothing.’

It is a story that echoes throughout the neighbouring countries of Niger, Burkina Faso, Mauritania, Senegal and Chad. More than 13 million people are now at risk of hunger in the Sahel, and aid agencies are now warning of a humanitarian emergency.

Young children are often the worst hit. In Mali, experts predict that 175,000 children could soon be suffering from severe acute malnutrition.

In Tapoa in Burkina Faso, aid agencies have reported a 200 per cent increase in admissions of malnourished children compared to 2010, and in Kanem in Chad, 2,000 children were admitted to Action Against Hunger treatment centres in February alone, a three-fold increase compared to the same month last year.

Erratic rains

The current food crisis is largely down to erratic rains and localized dry spells in 2011. As agronomist Oumar Niangado explains, agriculture in the Sahel has always been vulnerable to low rainfall. ‘In certain places there are good systems of agricultural collectives, plus strong NGO support,’ says Niangado, ‘but with our dependence on rain-fed crops and poor irrigation, one bad rainy season can ruin everything.’

This was the case in 2010, when drought triggered an acute wave of hunger that affected 10 million people in the region. The global food price spikes of 2008 were another shock that pushed the vulnerable into crisis once more. Meanwhile, Oxfam has warned that the world is entering an era of permanent food crisis, predicting that global warming and resource pressures may cause staple crop yields in developing countries to plummet dramatically over the next 20 years.

Oxfam has warned that the world is entering an era of permanent food crisis

Governments and NGOs are scrambling to prevent a repeat of the Horn of Africa famine, which is thought to have killed up to 100,000 people last year. Early warning alerts late last year prompted several Sahelian governments to set up food distribution programmes and issue calls for international assistance. In February, the European Union pledged €125 million ($166 million) in aid to the Sahel, while Britain has donated £3 million ($4.7 million) to the region.

Over the last two months, the World Food Programme (WFP), the International Committee of the Red Cross, Save the Children, Christian Aid and Action Against Hunger have all launched appeals. Relief efforts have grown more sophisticated than handing out sacks of grain. These organizations are attacking malnutrition with ‘blanket feeding’ (nutritionally rich food to the most vulnerable) and high prices with cash-for-work programmes, food vouchers and cash hand-outs. ‘We have to support local economies, says Nancy Walters, WFP Country Director in Mali. ‘If we can get commodities flowing freely, we can begin to meet people’s food and nutrition needs.’

But the deepening food crisis has another aggravating factor: the Tuareg rebellion in the north of Mali. Since the uprising began three months ago, it has hampered relief efforts and caused thousands of people to flee their homes, including a 23,000-strong exodus into northern Niger. On 22 March, the insurgency precipitated a military coup in Bamako, the Malian capital. Unless a swift resolution is found, this political upheaval and accompanying refugee crisis threaten to tip an already fragile region into a full-scale humanitarian disaster.

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