Uganda's Health Care System at Crossroads; No Functional Chain of Survival Systems

Ugandas Health Care System at Crossroads; No Functional Chain of Survival Systems

Currently, there are very few functioning Ambulances in the country, and where ambulances exist, they may not have fuel or drivers. Many times, patients with life threatening emergencies are told to go to the next high level health facility, only to wait by the road side for public transport, and this usually takes a while. By the time these patients get to the next high level health facility, most often, it is too late to save their lives, horror stories are many of women being transported on ‘Boda-bodas’ while they are bleeding during child birth.


It’s almost 2 years ago, when one of the Doctors in Uganda was suspended from practice by the Medical and Dental Practitioners Council over a death of a woman in labour. The reason was that this Physician was found guilty of not properly referring the woman and following her up closely. This did make news, and the Doctor paid the price for the ailing health system and nothing was done. Just to remind my readers that in Uganda, almost 20 women die every day from pregnancy associated complications, majority of them preventable, requiring basic medications costing a few shillings.


The ‘Real story’ about this case is as follows; The Physician who works at a District size Hospital in Entebbe, very close to the State House, saw this pregnant woman in his small Clinic( in his time off work). He noticed that she had extremely High blood pressure in pregnancy. He immediately counselled the woman and asked her to go for admission at the Hospital to be managed in order to prevent her from a stroke or seizures due to her High blood pressure. This woman went to the Hospital in Entebbe, and was examined. She was indeed unwell and required to have her blood pressure controlled with medications, receive medication to prevent seizures and have baby delivered as soon as it was feasibly safe for both mother and baby.


The Hospital, in the neighbourhood of Uganda’s State House, did not have the basic medications to save this woman’s life nor was it in position to perform a lifesaving caesarean section to deliver the baby. She was referred to Mulago Hospital-the National Referral Hospital. In cases like these, there should be immediate evacuation and transfer of the patient. But Ambulance services were not available for this woman, so she waited by the roadside for public transport from Entebbe to Kampala. After many hours, in the Taxi, she made it to Mulago, in a very critical condition, she was taken to the Operating room and developed complications and died and so did her baby. The Physician, who had referred her to the Entebbe Hospital, was penalized, his licence suspended, his name splashed in the papers, his reputation tarnished.


No one did ask the important questions;

  1. Why did the Entebbe Hospital, lack the basic supplies to treat a pregnant woman with high blood pressure or even be able to give her a lifesaving Cesarean section?
  2. Why was there no ambulance at the hospital to transport this woman to the National referral hospital on time?
  3. Whose responsibility is it to make sure that each hospital has the basic supplies and equipment to save a life of a pregnant woman and the unborn baby?

With the current broken Referral system, the death of this woman alone, should invoke a public outcry, and a debate about what should be done to improve our ‘chain of survival systems’.


What is next for Uganda?

Dr. Asa Ahimbisibwe is a Ugandan doctor doing postgraduate training in Obstetrics and Gynaecology in Canada.

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