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Uganda: Access

Travel: always illuminating, always an assault on one’s senses, always visceral. One returns from travel having a deepened understanding of self and others and circumstances. And so it was that in Uganda I came to know in a new way what is meant by “access barriers.” Access barriers. Policy speak. Jargon. It doesn’t come close to describing and defining the challenges faced by millions of women, men, and children around the globe.

Heading east from Kampala one morning, we passed Jinja, the fabled source of the Nile River. Somewhere in between Jinja and Bugiri we turned off the main, tarmac road and headed south toward Mayuge district. And it was along this road that I came to understand the meaning of the word “access.”

The road is a narrow, one-lane red earthen trail. On both sides the bush threatens to overtake; somehow, though, the road prevails. No doubt necessity plays a part, the road being the main – perhaps only – connection between the villages of the district and major arteries of the country. Of course, this doesn’t speak to the islands of Lake Victoria that are included in the district.

The road is deeply pitted. And where there is an absence of potholes there are rocks of all sizes and shapes pushing through the earth at haphazard angles. One could easily imagine how impossibly hostile the road would be after just a few minutes of heavy rainfall.

The road is deeply pitted. And where there is an absence of potholes there are rocks of all sizes and shapes pushing through the earth at haphazard angles. One could easily imagine how impossibly hostile the road would be after just a few minutes of heavy rainfall.

Having had three bottles of water already that morning, bouncing along the road became increasingly uncomfortable. The potholes and jutting rocks were coming fast and furious, and each jolt brought with it a sharp pain in my bladder. I winced. I held my breath. It barely helped. We seemed to be traveling in slow motion. I began to imagine the plight of laboring woman. At least I was in the relative comfort of a four-wheel drive vehicle. And I could always embarrass myself and my colleague by insisting that we stop. But what if I didn’t have these options? What if I were a pregnant woman, in desperate need of medical attention? What if the only way to transport a woman with delivery complications was in a wheelbarrow, or a cart? What must that feel like? How far would she have to travel? Along the 15-mile stretch of roads that I traveled that day I saw two health centers, one of which appeared closed, although public health centers are mandated to be staffed and open 24/7.

Imagine for a moment that you’ve been in labor for 8, 10, even 20 hours and nothing. Or you’ve given birth and you’re bleeding. Profusely. You need medical attention but the nearest facility is 5 or 6 or 10 miles away. And you have no car, no money. So your family puts you in a wheelbarrow and sets off along this road, this intolerably treacherous path. With each pothole the pain sears through your body. The potholes seem to come faster than the contractions, or the blood loss. And what if it’s been raining and the road has turned to mud. There’s a very strong probability that at some point you will get stuck. You can’t imagine it. It’s too unbearable. But what if you make it, survive the trek, only to find the health center closed? Maybe the staff are off working in a private facility somewhere in order to supplement their income? Or what if they had simply stopped working because the government hadn’t paid them in some months? What then? What option would there be but to keep going until another facility could be reached?

By the end of the day, having traveled along the bumpy, rutted road for more than three hours, coping at least half of that time with the pain of a full bladder, I was exhausted. All that bouncing! All that pain! It was all I could do the stay awake and I’m strong, healthy, and well-nourished. What about the pregnant, hemorrhaging, quite probably anemic woman in the back of a cart? Will she stay awake? And when she gets to the facility will there be anyone there? And will that person have the skills, and the knowledge, and drugs, and supplies necessary to keep her alive? Would things be different if that same woman had been given three little tablets of misoprostol to prevent the hemorrhage in the first place? Could she have been spared the journey? Might she have survived?

Uganda: Access

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