Photo: Dr. Marvin Miiro Nsubuga, a specialist in internal medicine in Kampala, Uganda. (© Muniini K. Mulera)

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 The overwhelming healthcare needs of Uganda’s population can cause as much despondency to health professionals as they do to patients and their families. The government’s efforts alone cannot meet the challenge. Even a relatively corruption-free low-income country would still struggle to meet the high cost of free health services. 

The private healthcare providers struggle to keep up, partly because of the high cost of state-of-the-art services. Whereas I have not looked at the balance sheets of the private hospitals and clinics in Uganda, I am almost certain that their net incomes are not as high as one might imagine. Good health care is very expensive. So, one understands the reasons for the very high fees charged by Uganda’s private health care providers. 

The problem is that the fees are well beyond the financial means of most citizens. I know this because I was involved in supporting a close relative’s healthcare during my recent visit to Uganda.  During lunch at CJ’s, a lovely restaurant on Acacia Avenue in Kampala, on Monday February 6, 2023, my relative became suddenly ill. The restaurant’s manager kindly called City Ambulance, which arrived within fifteen minutes. The emergency medical service staff – Arthur Agaba, Fiona Nsereko, and Sufficient Mariam – were very kind, and attended to the patient with world-class professionalism. Notwithstanding the traffic that blissfully ignored the ambulance siren and carried on with the usual madness of Kampala, the team safely delivered us to Nakasero Hospital. The patient was immediately attended to by Dr. Steven Walakira, Nurse Gordon Nduhuura, and other colleagues. Dr. Walakira and his team evaluated and treated the patient with efficient professionalism, and admitted her for continued care and monitoring, under the watchful eye of Joan Namata, a soft-spoken, kind, and knowledgeable nurse who explained her procedures and findings with courtesy and confidence. 

The next morning, the patient, who was feeling better, was transferred to the care of Dr. Marvin Miiro Nsubuga, a specialist physician in internal medicine.  Dr. Nsubuga was very outstanding by every measure. Very courteous, very knowledgeable, his care solidly grounded on evidence-based scientific medicine, with a superb knack for respectfully explaining complex matters to a non-medical person in a language that my relative understood very well.  He visited the patient again later that day, and thoroughly explained the findings on various laboratory and imaging studies that had been done, and the rationale for his recommendations for treatment. Prior to discharging the patient, he handed her the detailed medical record, and offered us his telephone number if we needed further advice. 

Dr. Nsubuga made a very good impression on me. If I was a medical student today, I would want him to be my teacher.  He is in the mold of great teachers like Professors Alexander Mwa Odonga, Paul D’Arbela, Bwogi Kanyerezi, Samwiri Kajubi, and Charles Olweny. 

Dr. Nsubuga was assisted by Jennifer Candiru, a registered nurse, who provided excellent care all day, without evident tiredness. She treated the patient as a person, not “a case”, that horrible phrase that some in the medical profession still use to refer to a patient by their diagnosis, not their humanity.  She talked to my relatives like old friends. The power of obuntu (humanness) was very evidently manifest in Ms.  Candiru.  

The patient was thoroughly investigated and appropriately treated the way she would have been had her illness occurred in, say, Nairobi, Toronto, Seattle, or Mumbai. I could not but wonder why well-connected and other well-off Ugandans fly to distant cities to get care that is available right there at home. My relative recovered fully and, by God’s grace, is doing well.  Should I need health care while in Kampala, I will gladly present myself to Nakasero or another reputable hospital for help.  

Whereas my relative had the financial means to afford the care she received, I was troubled by the cost of her care. Not that she was overcharged. Not at all. Indeed, I know that the fees she paid were below what she would have paid for similar services as a foreigner in Canada, or USA, or even India.  To be sure, the excellence of the service my relative received, and the highly positive testimonials I heard from a few individuals that had loved ones in that hospital at the time, was worth way more than she paid. 

My distress was at the reality of a Uganda that I never imagined possible. I had had a similar feeling during my father’s final year, 2019, when he had had a few admissions to another private hospital in Kampala. My father received excellent care, for which we gladly paid.  However, the irony was not lost on us that after decades of providing “free” medical care to Ugandans, my father’s final years brought him face to face with a world that was financially cruel to those most in need. That the cost of his care was not paid for by a society for which he had spent many sleepless nights, reminded me of the stories I had heard about many doctors and surgeons, very senior to him in the profession, who had died after being bankrupted by their own healthcare needs.  To witness first-hand, once again in 2023, this modern Darwinian principle of survival of the richest was very troubling. 

Here are two basic truths that are worth remembering. Every living person, regardless of socio-economic status, is entitled to suffer from the same illness that struck my relative. Every life is as precious as the other. I refuse to subscribe to the idea that the life of the country’s president or other public servant is more precious than that of my cousin Rwamutigaanzi in Kahondo ka Byamarembo or that of Icaya Ogwang of Kyoga. I believe that excellent health care is a human right that must neither be denied to any person, nor stratified according to socioeconomic stations. Life is life, precious to the owner and their relatives, and equal before God.

That is why I believe that people in Mparo, Serere and Moyo are entitled to the same access to quality health care as residents of Prince Charles Drive in Kololo. The healthcare that the president’s wife expects should be no better than that which is available to a catechist’s wife in Bundibugyo or a poor widow in Buruuli. This is a principle that, I pray, becomes foremost in every Ugandan’s thinking, not just about healthcare, but about all publicly funded social services. Equal access to equal opportunities. That is a non-negotiable right of citizenship. That is what God expects of us.

While the disparity in healthcare access is across the board, it is most prevalent in the maternal and child health fields. To be pregnant in upcountry areas is to double the risk of what should otherwise be a normal and happy state of womanhood. Whereas gains have been made in reducing maternal and infant deaths, the numbers remain unacceptably high. The morbidity among that segment of the population is a silent tragedy whose burden goes unnoticed except by the sufferers and their kin.  The prohibitive costs, and the inadequate resources in the public hospitals and health centres are two of the major contributors to this situation. 

I am a realist. I do not see the government and the public ever changing their priorities and making the necessary sacrifices that are required to provide excellent and free, or at least affordable, healthcare. Furthermore, lamenting about the problem without contributing to the solution is a fruitless undertaking. Ugandans at home and abroad need to increase support for public health care services in their respective communities through collaborative efforts. We can move towards achieving this goal by a mindset change that prioritises public healthcare services over things like donating money to luxurious lifestyles of our leaders in various aspects of life. Instead, we the normal citizens, beneficiaries of our land and opportunities that Uganda gave us, should seriously consider investing in our public healthcare facilities, to supplement the government’s efforts. 

This is a course of action that some people in various places in Uganda, including my adopted homeland of Mparo, Rukiga District, are already doing, not as a favour to our people, but as an obligation of citizenship. They are also investing in services that they themselves may need one day. Next week we shall tell you about the program in Mparo, and why, if you have not done so, you should consider doing likewise in your part of the country. 

© Muniini K. Mulera