Namayingo islands women crossing treacherous lake for childbirth
Ruth Achieng, a nurse at Hama who also acts as the facility in charge says she faces challenges in providing maternal healthcare due to limited resources and infrastructure.
A mother in labour. Pregnant women have to go to Kenya to deliver. (Credit: Betty Angatai ()
Achieng, who mans Hama Health Centre II, displaying available drugs at the facility.
NAMAYINGO - When Esther Atieno started feeling sharp pain, she did not know that she was in labour, considering that she still had three weeks to the expected date of delivery.
Atieno assumed it was just normal discomfort or the baby shifting position in the womb. However, the pain intensified, leaving her paralysed.
At about 10:00pm, a boat was got to rush Atieno, a resident of Lake Victoria's Wayasi island in Namayingo district, to the health facility on Mageta Island across the border in Kenya.
The baby could not wait: Atieno gave birth in the middle of Lake Victoria without assistance from a midwife and proper materials for childbirth.
“I had nothing to use during delivery. We had to cut the baby’s umbilical cord with a piece of iron sheet that was patched onto the boat,” Atieno says.
The dire situation was compounded by the heavy downpour immediately after giving birth.
“We put the baby in a tin we normally use to scoop water from the wooden boat, hoping to keep the newborn warm,” she recalls.
On arrival, at the Mageta health facility, another challenge towered over Atieno: The midwives hesitated to attend to her because she neither had a national identity card nor was she a Kenyan citizen.
“In Kenya, health officials prioritise their citizens. We were treated as intruders,” she explains, “the nurses questioned why I had not gone to a Ugandan health facility for delivery instead".
Despite her desperate condition, she was left unattended for nearly two hours. It was only after a long and exhausting explanation that they finally agreed to treat her.
Alumu's ordeal
Fredo Alumu Omondi, another islander, says his wife went into labour at midnight and it was difficult for them to hire a boat.
“It was extremely difficult for me to hire a boat because I had no money. In the past, it was much easier, but ever since fishing was banned in our area, life has become unbearable,” he says, adding that in the past years, he relied on his earnings from fishing to afford private transport but now without a steady income, saving his wife’s life felt impossible.
As minutes passed, her pain worsened, Alumu desperately searched for a way to get her to the facility. The once simple task of hiring a boat had become a daunting challenge, one that put both his wife and unborn child at great risk.
According to Alumu, at about 3:00am, after hours of searching, he secured a boat and rushed her to Hama Health Centre II, on another island.
However, upon arrival, the nurse examined and informed him that his wife’s condition was beyond what they could handle. She needed more advanced care and was referred to Buyinja Health Centre IV, a larger facility located on the mainland in Namayingo town council.
At that moment, fear and helplessness overwhelmed him.
“I started trembling. I couldn’t bear the thought of watching my wife die right before my eyes,” he recalls, “she was in unbearable pain and deep down, I knew I didn’t have the 60 litres of fuel needed to transport her to Busiro Landing Site, a five-hour journey by boat followed by another one-and-a-half-hours to Buyinja.
With no other option, he made a difficult decision to sail to Kenya in search of medical assistance, but the journey was treacherous.
“The lake was bad that night. The waves were strong and I kept battling them to move forward,” he recalls adding that by the time they reached the health facility, they were both soaked from head to toes.
A big challenge
For Atieno and many others living on Wayasi Island, the absence of a nearby health facility continues to put their lives at risk, especially when urgent medical attention is needed.
“Women here have to endure great hardships during childbirth because there is no health centre in our area, not even a private clinic or a simple drug shop exists here to handle emergencies. If a pregnant woman needs medical attention, she must travel all the way to Hama or another island in Kenya, which is not always easy, especially at night or during bad weather,” Julia Akinyi laments. Wayasi Island has a population of about 500 people.
The residents say the lack of a nearby health facility has left them vulnerable with many getting services from traditional birth attendants on the island to save lives.
Are politicians silent?
Davelyne Adiambo, a resident of Wayasi, expressed deep frustration over the lack of a health facility blaming elected leaders for failing to address the community’s urgent healthcare needs.
“For us women living on islands, elections have become a cycle of unfulfilled promises. Each political season, leaders arrive seeking votes with pledges of improved services, yet once elected, they disappear leaving us without even the most basic maternal healthcare,” Adiambo says.
“Our voices must be heard not just at the ballot box but in the policies and services that shape our daily lives,” Adiambo says.
She notes that many residents are left to survive by sheer luck as they cannot afford the cost of travelling to other islands for medical care.
Adiambo says expectant mothers in the area are risking their lives due to the lack of accessible maternal healthcare services. She adds this has forced many to travel long distances for antenatal care, a journey that is both costly and challenging.
Prioritise healthcare
She has called on the Government and local leaders to prioritise the establishment of a maternal healthcare facility for safe deliveries and also provide water ambulance to ensure emergencies are handled in time.
With no local clinic to cater for pregnant women, some are left with no choice but to deliver at home under unsafe conditions or seek help from traditional birth attendants (TBAs).
Rosemary Ajambo, a resident of Syamulala village on Hama Island, says she gave birth to some of her children with the assistance of TBAss due to limited healthcare services in the area.
“I have six children and two of them were delivered with the help of a traditional birth attendant. For the other four, I had to travel to Kenya for better care,” Ajambo shares.
As a member of the LC1 committee, she is now urging the government to upgrade Hama Health Centre II to improve healthcare access for residents.
“Hama facility is only a grade II health center with just one nurse who is responsible for all services, including maternity care, laboratory tests, immunisation, HIV clinic and other medical duties. This single staff is overwhelmed,” Ajambo says. She adds that the facility is also small and lacks equipment.
She expressed concern that many critical cases have to be referred to distant health facilities thus causing health complications and sometimes deaths due to delays in receiving proper medical attention. She asked government to provide a standby ambulance boat to facilitate emergency referrals.
Hama Island’s health facility serves not only the 7,000 residents of Hama but also those from neighboring islands of Siro, Wayasi and Syamulala, It is essentially a referral facility for all islanders yet it lacks resources.
TBA rooting for midwives
On this island, Jeniface Nachwere, a traditional birth attendant is always available to assist mothers during childbirth. When I interacted with her, she took great pride in helping women bring new life into the world.
Nachwere has been practicing as a traditional birth attendant since the 1960s, a skill she learnt as a teenager from her mother, a devoted Legio Maria believer who had dedicated her life to helping women during childbirth. Inspired by her mother’s compassion and experience, she followed in her footsteps, spending decades assisting pregnant women in her community.
“I have spent many years helping mothers and most of the babies I delivered are now grown and married,” she recalls.
She adds “However, due to my age and government restrictions on traditional birth attendants, I can now only assist about five to seven deliveries,”
It should be noted that Uganda officially banned TBAs in 2010 but they have continued to practice. Many rural women prefer TBAs to trained midwives. On this island, Jeniface Nachwere, a traditional birth attendant is always available to assist mothers during childbirth.
Nachwere says with Ugandan government discouraging reliance on traditional birth attendants, she now refers most expectant mothers to the health facility whenever possible.
“Last month, I assisted a mother in delivering her baby only because the nurse was not available at the facility. Otherwise, I try to send them for medical assistance whenever I can, she explains.
Nachwere admits that despite the restrictions, many women still turn to her for assistance not only for childbirth but also for traditional herbs and pregnancy checkups.
She points out that the shortage of trained medical staff at the local government health facility, along with transportation challenges has left many expectant mothers with no choice but to seek her help.
“Expectant mothers frequently visit me to either check the position of the fetus in the womb or seek herbal remedies for common pregnancy-related concerns,” she explains adding “with years of experience, I have gained their trust and they rely on me for guidance and care when access to medical facilities is limited.”
Cross-border healthcare arrangements
Beatrice Nabukonde, a resident of Makindye village, reveals that some island residents have resorted to informal cross-border healthcare arrangements with Kenyan nationals to access essential medical services.
“Pregnant women from Ugandan islands often depend on relatives, friends, and community networks in Kenya for maternal healthcare. As their due dates approach, they arrange to stay temporarily with Kenyan families to ensure they can deliver safely in a health facility,” Nabukonde explains.
Relocating
Francis Koowa, a resident of Hama, shares a similar experience. He says that whenever his wife nears her due date, he takes her to Namisu village in Mayuge district where she stays with relatives until after delivery.
“This poor healthcare situation forces us to relocate our pregnant wives when they are around seven to eight months along to ensure they have access to proper medical care,” Koowa says. He adds that due to financial constraints, he relies on public transport, which only operates on Wednesdays and Saturdays.
A tall order
Ruth Achieng, a nurse at Hama who also acts as the facility in charge says she faces challenges in providing maternal healthcare due to limited resources and infrastructure. On average, she handles between five to seven deliveries per month while 30 to 40 expectant mothers seek antenatal care at the facility.
Achieng notes that due to lack of adequate medical personnel, equipment and space, she is often forced to refer patients to larger health facilities on the main islands of Lolwe and Sigulu or the mainland facility of Buyinja.
She further points out that mothers from other islands without health centers are forced to sail across the water to access treatment and antenatal services at Hama Island.
“At this facility, there are many cases beyond my capacity. I am left with no choice but to act in order to save lives. The reality is that these mothers have nowhere else to turn,” Achieng explains.
The situation is not unique to Hama Island. At Siro Health Centre II, there is inadequate space, forcing male and female patients to share a ward due to a lack of proper medical infrastructure.
To help bridge the gap, Achieng works closely with village health teams (VHTs) to conduct community sensitisation, immunisation and outpatient services.
American aid cut hits hard
She also recalls a time when she received additional support from MJAP (Makerere Joint AIDS Programme), which had deployed three staff members including a clinician, linkage facilitator, mentor mother, and data clerk to assist with healthcare services.
However, following the policy changes under United States President Donald Trump, the support was withdrawn leaving the facility understaffed once again.
Namayingo Assistant District Health Officer Mathias Mangeni acknowledges that despite the Government’s continuous efforts to improve healthcare services, significant gaps remain in delivering quality medical care to the island communities.
Left isolated
Namayingo district comprises three island sub-counties of Sigulu, Lolwe and Bukana, yet it has only three health centres III and five health centres II to serve the entire population. Mangeni says many inhabited islands remain without health facilities leaving residents isolated and struggling to access medical care.
“We have numerous habitable islands without a single health facility. These islands are extremely remote, and reaching them is both difficult and costly,” Mangeni explains. Some of these islands include Yebe, Bisa, Wayasi, Syamulala and Migingo (furthest) among others.
He says even though the district has a ferry, its routes are limited, connecting only three of the 13 islands and this leaves many residents with no reliable means of reaching healthcare facilities during emergencies.
Rajab Mubbarak Muyonga, a district councillor for Dolwe Island, stresses the high financial burden associated with medical transportation. He notes that hiring a private boat for an emergency can cost between shillings 300,000 and shillings 500,000 during the day, while night-time emergencies can cost up to shillings 700,000.
“Besides hiring a boat, you also need to arrange for transport on the mainland because our district has no road ambulance (vehicle) to ferry patients to major health facilities,” Muyonga explains.
He also points out the dangers and risks associated with bad weather which in most time make transport impossible.
“We struggle a lot, especially when the lake is rough. Sometimes, we are forced to wait for the weather to calm down, but sickness and childbirth don’t wait. Even boat owners refuse to risk their lives sailing in bad weather leaving patients stranded,” he adds.
Ambulances and boats
Mangeni reveals that the government provided three boat ambulances under GAVI, including two fiber boats to assist with emergency evacuations. However, due to the high fuel consumption, the boats remain largely unused.
“The GAVI boats are fast, but the cost of running them is very high. The Ministry of Health allocated a fuel card covering 600 liters of fuel yet one boat uses it up in just three trips,” Mangeni explains.
He adds “When we have fuel, we use it and when we don’t have, we park the boats,” he adds, calling for a sustainable solution to operate the boats effectively.
Change strategy
Mangeni urges the Government to revise its budget allocation formula for island sub-counties, arguing that islands face unique challenges compared to mainland areas. He says 75% of the district is covered by Lake Victoria.
“The budget is allocated equally between mainland and island communities yet the islands have distinct challenges. Some are isolated and hard to access requiring more resources to provide essential services,” he stresses.
Chief administrative officer Friday Kyomya also emphasizes the need to operationalize Sigulu Health Centre IV theatre, which was constructed but remains non-functional due to a lack of equipment.
“The theatre in Sigulu was built but without equipment, it cannot serve the people. We need to secure funds to equip it so that it can handle medical emergencies,” Kyomya says.
Mangeni further calls for the upgrading of Hama from health centre II to III level, noting that Lolwe HCIII, which serves a population of 30,000 also requires urgent prioritisation to handle emergencies.
He also notes that many Ugandan islanders struggle to access medical care in neighbouring Kenya due to bureaucratic restrictions.
“In Kenya, healthcare facilities assign patients a unit identifier number linked to the national health system. Ugandans who attempt to seek treatment there face challenges because they lack this number and are not recognized as Kenyan citizens,” Mangeni explains.
He urges the health ministry to strengthen cross-border healthcare collaboration and integrate it into the East African Community (EAC) healthcare plan to improve access to medical services for Ugandans living in island communities.
Although Uganda has made strides in improving maternal health rural and hard-to-reach areas continue to experience high mortality rates and other complications resulting from childbirth.
According to district health reports, about 40 out of 100 women and teenage mothers give birth outside formal health facilities. Uganda’s maternal mortality ratio according to the Uganda Demographic and Health Survey 2022 stands at approximately 189 deaths per 100,000 live births, with rural areas bearing the heaviest burden.
This story was first published in The Weekend Vision of March 22-23, 2025, edition