My work this week has been in the community, meeting women, health workers, and Village Health Team members to learn about barriers to emergency obstetric care for the residents of this small, rural corner of the country. We have been talking a lot about obstetric fistula, which is a problem estimated to affect only 2% of women in all of Uganda’s nearly 40 million person population. Like most health problems, fistula disproportionately affects the poor, and obstetric fistula can leave women isolated and ashamed due to the incontinence and urinary leakage it causes. A huge problem for a small number of women, this is often not addressed in maternal health campaigns that aim to have a larger impact. But as one woman pointed out to me today, of course the disease or death of one woman affects more than that one woman. In isolation, she is unable to contribute to the larger community, which needs her in order to develop and grow together. Desmond Tutu would call this Ubuntu: a person is a person through other people and I am what I am because we are what we are. The personal is what creates the community, one individual at a time, and each piece is necessary.
At home, my family and community are mourning a loss of our own, and when I received the news over iMessage, I wanted to fly home where I would not have to cry alone. The social circle I grew up in, the friends who became our family, are all hurting by this loss and will continue to miss our friend. I can’t be there now, but I can be here, and I can grow in my new, temporary community in Uganda. I feel like I’ve just arrived, but already I’ve learned so much.
My internship host organization is Progressive Health Partnership, but more specifically my work is through the Omukazi Namagara Program (ONP). The Runyankore phrase means “The woman is life,” hence the focus on maternal health. Our population is small, only about 70,000 people live in the 2 sub-counties our program serves, but the need is great. About 50% of women in our partner communities delivered at home before the ONP began, and although for some women this is a choice based on traditions and personal desires, for many it is the only option. Transportation to a health center can be prohibitively expensive, and at the health center women or their caretakers have been turned away until they have bought supplies for the delivery. The health care workers are overworked and the centers are understaffed; at night a woman in labor may find the health center empty and dark.
Since Omukazi Namagara, closer to 20% of women are delivering at home, and when you consider the high fertility rate (Ugandan women average 6.6 births over the course of their lives) and the high number of pregnancies in this area, that is a really impressive change. Still, there are so many stories, so many challenges, and too many infants dying. And each loss is felt by a community that needs each member, because we cannot be whole while there is suffering for any among us.
I didn’t have to come to Uganda to see poverty; it’s there in Ann Arbor and even in the quiet suburb where I grew up. Public health happens everywhere, and I could just as well have sent the money for my plane ticket to some charity and stayed close to home. But while I am here, I can learn lessons that a power point can’t show me and hear what my professors can’t teach. Problem solving on a global scale requires so much listening and collaboration, because in population health no two populations are the same. I am a part of a new community here even while I miss the one back home.