A reflective blog from Nisha & Fiona

OBSERVATIONS ON HEALTH CENTRE TOUR

Our aim this week is to go out and see for ourselves what the Ugandan health care workers are up against when safely delivering pregnant women throughout the region. So for this blog post we thought we’d bring you along with us to give you a flavour of what we found…… We left Masaka heading southwest towards Rakai district on unusually smooth, paved roads, gently weaving around the motorbikes (boda bodas) laden with people and bananas. Shacks and small one-room buildings line the roads in town, selling metal doors, plastic buckets and bowls, and all the phone credit you can use.

Occasionally, joints of meat hang for sale in the sun, and small thatched shacks offer pyramids of tomatoes, watermelons, potatoes and the occasional avocado.

After some time we leave the main road and are unceremoniously catapulted onto ‘real’ Ugandan roads made of compacted dusty, red and rutted earth. We slow to almost a crawl at points, picking our way through banana fields, past students being taught beneath the shade of a tree outside their school, until the buildings thin out to just one or two scattered across the rolling hills. The 20 or so kilometres takes us over an hour, and are uncomfortable enough for us in our sturdy van let alone how it must feel for a woman in the throes of a difficult labour heading for help on the back of a boda. Nisha’s pedometer registers 6000 steps – confirming our feelings of being thrown around inside the car. Progress is slow, but we finally reach the village and turn into the health centre.

Outside, we see queues of young men and boys listening to a lecture under a tarpaulin advertising safe male circumcision. We’re told they’ve been collected in government cars as part of an outreach HIV prevention project, and later today will each make the call of whether or not to go ahead with a circumcision, right here and now, before the ride back….. We walk on towards the scattering of delapidated buildings that make up the health centre, which a member of staff later tells me he is worried will all soon fall in on their heads. We share his fears.

We find the course graduate that we’re visiting in the labour ward – the ward is empty, and strikingly filthy. This is a level three health centre – in theory two steps down from a hospital, yet there are no drugs, no syringes, no gloves and often no water available here. Patients’ families are sent to the village drug store to buy their own, but the midwives themselves agree that the cost of the gloves alone (officially a requirement) can be prohibitive. A Ugandan colleague gamely volunteers to be our ‘mystery shopper’ and try out the drug store and it’s a sobering experience. Although she does come away with a sealed strip of paracetamol, albeit with no date stamp.

Against this backdrop we now understand more than ever the importance that the RCOG faculty place on urging trainees to become advocates, lobbying for the resources that should be provided, rather than only teaching new clinical skills. We have huge sympathy with the health care workers struggling to function in these conditions, but perhaps stronger sympathy still for the mothers for whom this represents the best and only source of help. It’s a grounding lesson in what our behaviour change theories and techniques are up against in this part of the world – but also a challenge calling behavioural scientists to action: The reality facing this midwife in this health centre on her return to work seems to have drained her initial post-course enthusiasm pretty fast – how can behavioural science help to sustain her motivation and sense of empowerment long enough to overcome some of the barriers, and keep going long enough to make a difference?

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