How Northern Uganda’s doctors are playing Russian roulette with your health

____________________

OPINION

By Dr Bob Marley Achura

In a private clinic in Lira last month, 5-year-old Ocen was tested for his persistent fever. The lab report came back stamped with a familiar phrase: “bacterial infection.” His mother, relieved, asked the doctor which bacteria was responsible. The reply was vague: “It’s just bacteria.” Moments later, she was handed a prescription for ciprofloxacin and sent home. Two days later, Ocen’s fever was worse. When finally tested for malaria at another facility, the truth emerged. He had never had a bacterial infection at all.

This is the quiet scandal across the Acholi and Lango sub-regions. Patients often go through the ritual of laboratory testing, yet the results almost always arrive with two labels: “bacterial infection” or “typhoid fever.” Rarely do they name the specific bacteria involved. When pressed, doctors grow elusive. Which bacteria is it? Resistant or sensitive to which drugs? The answers are never given, but the prescriptions come quickly, powerful antibiotics handed over without scientific clarity.

What appears to be modern medicine is, in truth, a dangerous guessing game. Families like Akello’s in Gulu Town know this pain well. Her nine-year-old daughter battled recurrent fevers for months. Every visit produced the same test results, the same antibiotics, and no lasting recovery. The real diagnosis of viral infection came only after her condition deteriorated. By then, her immunity was weakened, and her family’s savings were drained.

James, a boda-boda rider in Kitgum, tells a similar story. His stomach pains earned him a “typhoid fever” result at a private lab, followed by rounds of antibiotics that did nothing. When he sought care from a regional hospital, the truth was finally revealed: he was suffering from a parasitic infection. The antibiotics had not only been useless but harmful, disrupting his gut health and worsening his recovery.

Even healthcare workers are not spared. Margaret, a nurse in Lira, once confided how she struggled with a persistent cough. Each test came back as “bacterial infection,” and each doctor scribbled a different antibiotic. Only much later did she learn she had a fungal infection that no antibiotic could ever cure. As she put it, “I am a nurse, but I realised I had been gambling with my own health.”

The resistance crisis nobody talks about

Every unnecessary prescription feeds a monster: antimicrobial resistance (AMR).

At Gulu Regional Referral Hospital, Dr. Peter Olwoch has seen resistance grow before his eyes:

“Ten years ago, urinary tract infections responded to cotrimoxazole. Today, more than 70% of cases resist it. Families now pay for expensive second-line drugs, if they can afford them.”

The statistics are grim:

• 73% resistance to cotrimoxazole among E. coli in Northern Uganda
• 65% resistance to ampicillin in common bacterial infections
• 40% failure rate in patients presumptively treated for ‘bacteria’

This isn’t just wasteful, it’s deadly. When antibiotics are truly needed, they may no longer work.

The economic toll on families

The antibiotic lottery is bleeding families dry.

A bacterial culture test costs sh25,000, yet a UBOS study found that households in Northern Uganda spend an average of sh85,000 annually on inappropriate antibiotics. Families are paying more for wrong treatment than they would for an accurate diagnosis.

For Margaret Atim, a market vendor in Lira, the frustration is endless:

“My daughter gets sick, we test, and they say bacteria. If she doesn’t get better, we will test again, still bacteria. More antibiotics. By the time she recovers, I have spent money meant for school fees.”

In Kole, farmer Patrick recalls spending UGX 100,000 in three weeks on antibiotics for what turned out to be dengue fever. “I nearly sold my cow,” he admits, “for the wrong medicine.”

Why doctors keep prescribing in the dark

It isn’t incompetence, it’s systemic failure:

• Laboratory deserts: One functional microbiology lab per 500,000 people, compared to WHO’s one per 100,000.
• Time pressure: Doctors in rural areas see 60–100 patients daily. Waiting 3–5 days for accurate results feels impossible.
• Patient expectations: Communities equate “no prescription” with “no treatment.”
• Pharmaceutical pressure: Some clinics get incentives for high-volume antibiotic sales.

As Dr Charles Okot at Lacor Hospital notes, “Without reliable labs, every fever becomes ‘bacterial’ or ‘typhoid.’ It’s easier to write antibiotics than to admit we don’t know.”

These stories and statistics point to a systemic failure. The medical act of diagnosing has been reduced to vague labels that justify prescriptions rather than illuminate causes. A fever could be viral, parasitic, or bacterial, but in northern Uganda, it is almost always branded “bacterial infection” or “typhoid fever.” The consequences are profound: antibiotics are wasted, resistance spreads silently, and patients lose both health and trust.

This is not just about medical accuracy; it is about justice. Communities in Acholi and Lango deserve healthcare that respects science, transparency, and dignity. They deserve to know not just that they are sick, but what exactly is making them sick. Every vague diagnosis chips away at trust in the health system. Every reckless prescription pushes us closer to a future where antibiotics no longer work.

The solution lies in deliberate reforms. District and national authorities must invest in well-equipped laboratories capable of identifying specific pathogens, not just rubber-stamping “bacterial infection.” Private clinics, where shortcuts are most common, need tighter regulation to ensure that diagnoses and prescriptions follow clinical guidelines rather than profit motives.

Above all, patients must be empowered to ask questions and demand clear explanations before swallowing a prescription. Every patient has the right to know whether they are fighting E. coli, Staphylococcus, or a viral infection that doesn’t require antibiotics at all.

If Northern Uganda fails to act, the misuse of antibiotics will quietly erode the effectiveness of the very drugs that keep families alive. But with stronger labs, stricter oversight, and patient-centred care, the region can break this dangerous cycle and preserve antibiotics for the battles that truly require them. The choice is urgent, and the cost of inaction will be measured in lives.