Maternal and Child Health: Breaking barriers in rural Uganda

The sun was just beginning to rise over the eastern shore of Lake Victoria when our trip began. Destination: Mannya, a small village situated about 160km from Kampala. It takes us more than four hours to finally get there, through endless plantations of corn, coffee, tobacco, and forests shining emerald, mint and lime green, such as I had never seen before in Africa.

It is clear to see how generously the Katonga River irrigates these lands.

On the way to Mannya we pass through a number of small villages: simple huts made of straw and wood, a well here and there, and many young women and children at the edge of the road, staring at us with curiosity, sometimes waving at our car.

The last 9km are the worst: it rained only a couple of days ago and the road – more like a mudslide – is almost impassable. It gives us a taste of the kind of difficulties that people from the nearby villages have to face when seeking care at the Health Centre we are on our way to visit.

The buildings of St. Bernards do not look as I was expecting: the health centre is composed of about ten ordered small houses with sandy beige and scarlet walls, so similar to the colour of the land here.

Elegant gardens and hedges surround the buildings. At the entrance, waiting for us is a very tall man, at first glance I estimate 6.5 feet probably. He has steady hands that he opens in a hug-like gesture to welcome us, and a calm smile.

His name is Vincent, director of the centre and our guide for today.

Vincent, a clinician from Kampala, has been working in this rural area for four years now. His first words are filled with the sense of pride he has in showing us around and it becomes obvious how dedicated he is to his work. We start our visit.

Vincent introduces us to his colleagues, mainly nurses and midwives, whilst explaining the activities of the centre and why offering maternal and child care services is so crucial in such an isolated area of the country.

“When I first arrived here, one of the main challenges was to convince pregnant women to even visit the centre! There are so many barriers involved. Fertility rate is high in the region.[1] When a mother delivers her first, second and even third child at home with no complications, she thinks that she doesn’t need any kind of support. Sometimes they would like to come here, but don’t have any means of transport and travelling would be either too long or too expensive for them. Sometimes they are just ashamed of their poor clothes. We have been working closely with the community to help these mothers to understand why it is important to seek care during pregnancy and after giving birth.”

The situation that Vincent describes seems to be very common in other areas of the country as well. As Theo, Clinical Officer at the Kitovu Health Care Complex, who accompanies us during our visit, explains:

“The fact is that today in Uganda only 42% of mothers are attended by skilled health workers. The cause is what we call here ‘the three delays’: one for socio-economic reasons; a second one for geographical barriers, and finally because once the mothers have finally decided to seek treatment they might not find a skilled health worker or a health worker at all!”

The training that Vincent received through the RCPCH-Kitovu partnership addressed this problem, by underlining the importance of building a relationship based on reciprocal trust with the patients.

“Mostly people were scared of coming to the centre. The training taught me how to speak to patients in the right way. And at the same time I could teach colleagues here how important it is to treat patients respectfully. Things are slowly changing. Women are more and more comfortable and have started appreciating the benefits of consulting a clinician when pregnant or after they deliver. They talk among them and for us this means that the number of patients we see regularly has been increasing, with incredible benefits for the whole community.’

To read the full case story please click here.