LYING motionless in the â€˜septic sideâ€™ of Jinja Hospitalâ€™s womenâ€™s ward, Olivia, 25 is a typical case of anaemia. This can be seen through her white eyes with swollen eyelids and feet.
Her life seems dependent on the blood and water drips attached to either hand. Her mother Nabirye says: â€œWe came yesterday and were admitted. My girl almost died. At least now, she has some sign of life,â€ she adds.
Sister Dorcus Omara, a senior midwife says Olivia had an incomplete induced abortion which caused a serious infection. â€œShe was severely septic, that is why she is on this side of the ward (Septic side). We separate such cases from others to avoid cross infections and an unpleasant smell,â€ Omara explains.
The ward admits patients with postnatal problems like vaginal fistulas, post partum haemorrhage, or those recovering from caesarean birth complications. Others include women with fibroids, cervical and other uterine cancers plus abortion complications.
However, Omora says majority of the cases on the wing are related to abortion. â€œWe get an average of 30 abortion-related cases a week,â€ she says.
Although their haemoglobin test levels (HB) are assessed, and antibiotics administered, majority are advanced cases requiring removal of retained products, administration of strong antibiotics and blood transfusion because of over bleeding and infection.
Omara says since abortion is hurriedly and secretly done, victims never think of the resultant complications because at that time, getting rid of the pregnancy is the only thing on their mind.
Big need, few resources
Ruth Nanziri, the in-charge of Namwezi HCIII, a sub sub-county level facility in Jinja district under Njeru town council regrets that many level III and IV health centres do not have the medical supplies or sufficiently trained health professionals to provide post-abortion care.
Although her health centre serves 56,426 people-an average of 2,426 infants below one year; 2,826 pregnant mothers and a general population of 11,399, it has no stethoscope, weighing machine or special dumping ground.
Located on a highway and in a densely populated area, many mothers who cannot walk long distances to the main Jinja Hospital (about 7km away) find it convenient to walk to Njeru.
â€œIt is disappointing when they come with malaria in pregnancy only to be turned away,â€ she says. The centre gets about 30 strips of adult coartem drugs in three months, yet about 60 patients, (80% re malaria cases) visit it daily.
The situation is so bad that even oxytocics (drugs that help induce contractions or expel retained products in case of incomplete abortions) are not provided.
With only two midwives and no ambulance, patients like Olivia are forced to stay at the health centre longer as public means like taxis hesitate to transport them due to foul smell.
Margaret Ashasha, a trained public health worker, regrets that many girls have died at their hands even when they have struggled to seek health care, mainly because they either report when it is too late or the facility is handicapped to provide the necessary care.Ashasha says the centre has no blood pressure gadget, they only use baseline pressure and no strong antibiotics for abortion cases.
Why the neglect
Before 1906, Jinja was a fishing village that benefited from being located on long-distance trade routes. It later became the industrial town of Uganda because of its strategic location near the power generation plant that serves the whole country.
However, while it is no longer the home of industries, it still thrives on sugarcane plantations, brewing plants, and tourism because of the many water sites.
The fact that it is still, a long route for distance tracks from Mombasa port, it is the most disadvantaged town in terms of health.
Asasha says because of itâ€™s stability politically and proximity to the city, there are hardly any health interventions especially from non-governmental organisations.
â€œMost NGOs are concentrated in the troubled northern and some eastern parts of the country at the expense of equally disabled parts like Jinja,â€
â€œYet, like any tourist destination there is sex trade to cash in and consequent unplanned pregnancies. Our girls and women are dying,â€ she says.
However, despite the constrained environment in which the health workers operate, Jinja Hospital is a true story of effort.
It is visibly clean, despite the congestion, with adjacent building blocks under renovation.
The hospital records an average of 12 deliveries a day, forcing staff to discharge mothers on normal delivery within 24-hours to create room.
â€œThere are times I have delivered babies with my bear hands when there are no gloves because I am trained to save lives,â€ says Sister Sarah Nanyonga, a midwife.
Expecting mothers are asked to take basic essentials like delivery sheets, razor blades, gloves, a basin and changing clothes to ease the nursesâ€™ work.
Rather than lament about chronic under-staffing, the midwives have revised their schedule to conveniently shoulder each other.
The New Vision found that, the maternity ward, labour suite, intensive care unit and surgery wards have two midwives each, assisted by nursing aids and interns. Ideally, they would be eight midwives on each ward.
â€œTo work effectively, we need about 15 midwives on each ward but we have only eight to cover morning, afternoon and night shifts,â€ says Sister Margaret Kakaire, the hospitalâ€™s weekend in-charge. They double in administration, records and supervision.
Kakaire says they are trying to organise health education outreaches to sensitise schools on dangers of unprotected sex, abortion and general reproductive health education.
â€œAbortions peak in holidays, when children are back from school. We advise them to use condoms.
However, schools need to organise counselling and routine checks for their girls.
They must also organise counselling sessions for female students,â€ she says.
Jinja hospital maternity wing weighed down by few workers