UGANDANS ARE AT GOD'S MERCY: A CASE OF RURAL IGANGA

The health situation in rural areas, like in slummy town-sides makes life meaningless and cheap. When one moves around slums of Kampala, he or she realizes that indeed it is God exclusively maintaining life there.

In rural areas, the same God, known to provide rains determines welfare and well-being. If it never rains the greatest part of the year, as much expected, communities will not have anything to sell or eat.

Due to global warming, climatic features that once characterized two seasons, today it is more pronouncedly one rain season. What was formerly the second season of the year, has only turned out to be phase of harsh punishments from the gods of nature -for man's failure to show concern amidst continued degradation of the environment.

The one season phenomenon is still alien to the farming community. It is only a handful technologically advanced farmers that cope well. Alongside the money-oriented small holdings, sooner than later, we see and hear cries of starvation, malnutrition and death. Imagine man dying at the same time as his livestock for failing to pay back in fairness what he would have eaten from the mother earth.

Without food, eating and selling, which increases people's ability to better their nutrition health and promote socio-economic order, becomes something to remember. They, for example, would not afford buying fish, eggs, meat, rice etceteras. The food trafficking to Juba, Southern Sudan, has gone down to choke food availability in households -helping neighbors heal faster from the traumatic events of the historic wars.

And storage, as of now, is a strategy of the past that often was an initiative of government. Unfortunately, society is at the crossroads between finding answers from who should be providing leadership at national planning level; whether themselves or a matter for the gods or entrusted leaders.

No wonder custodians of gods are thriving so much today to fill the leadership gap. When neither responds to the starving man, some sections of society opt for non-traditional food menu -as rats or mice. Yes, even people. Perhaps we could establish whether it could be linked to the human sacrifices that have plunged the country in more than six months.

And yields being poor in the much anticipated second season -as has been the case this year, neither money from crop sales nor nutritional requirements would be met. Because of that, malnutrition is commonest in rural areas especially among children under five years.

Poor or no sales this year has not only affected the ability to pay, but led to poor attitudes towards condom use, sanitation and the use of mosquito-nets. There have been survey reports that reveal some people in rural areas buying nets only for keeps or for weird purposes -as to fish.

People no longer care any more about possible health outcomes resulting from dangerous attitudes towards proper health and sanitation. They prefer to live only for today rather than wait for what tomorrow has to offer.

In the promotional of health behaviors, usually social marketeers attempt to offer products at subsidized fee. Unfortunately, under the circumstances noted above -as poor attitudes to good health, communities would still find it either difficult to purchase or just uncaring.

Preferably, they could be provided free of charge for impressively better community intervention results. Surely, the notion usually put forward during the course of interventions that communities would not effectively use free products and services, was not the case for villages in Iganga -as Busembatia, which is one of the uganda village project outreach sites.

Considering the swampy environment that tend to attract mosquitoes, rural people in Iganga -even whilst facing food crisis -were keen and buying and using net. Some, though, reportedly used extra mosquito-nets for fishing, while others kept the extra ones for future use.

One cannot undertake a behavioral change program -without recreation activities for the youth or community in general. Hardly can one find a community recreation centers throughout the district. In any case, community members created their own in the names of gambling and dating centers in place of the failed economy.

Being idle and disorderly is a form of lifestyle there. If major general Kale Kaihura decided to arrest those implicated in such an offense, mainly adult men and young women would test prison life. Adult women and children would escape -since they are most productive at home and in shambas.

Because of the muted development activities, communities there are often willing to cooperate with visiting non-government organizations to formulate development plan and venture into it together.

When it comes to work-time or implementation stage, the lazy ones tend to pursue a “fulfilling” passive responses -where upon deciding on community development action, they will not appear in the field. While if forced to cooperate, that alone becomes a source of trouble -unless force-and-eliminate-out-of-the-village tactics are used.

Commonest challenge is ever having to walk between a kilometer and two kilometers to find a nearby health center when sick. Those, who fail to make it during emergency cases resort to local herbs or lose themselves (mainly children) to death. Then, when one does his or her best to arrive at the health center, it is like an insult to an injury -as he or she is encountered by news of lack of drugs.

The prompt action by medical workers is usually to refer them to specific drug shops, but noting that famine has plunged the region with no crop sales virtually in the second part of the year, the patient opts to go back home and wait for fate.

There are cries to have a simple health unit erected in the village, but it remains a responsibility of government. In one village, Butongole, community leaders revealed five child death cases just in the middle of the year (June).

The public health option would be to negotiate with public health institutions or clinical practice schools -to have their students -both local and foreign health workers intern at various villages, with funds for equipment allocated by district health services office.

This could help reduce pressure on health workers by huge client or patient visits and fill gaps of limited personnel. But sometimes these approaches, as usual, could be affected negatively by grave lack of medical supplies.

For that village health centers can be excused, but not the case of negligence. If president Museveni's patriotism crusade serves its true purpose, it could bring sanity back into the lives corrupt-prone service-chain managers and grass-root health services executors.

If a whole district hospital can be reported as having no medical equipment, even the very simple and basic ones: how sure can anyone be if programs like mobile health services delivery will be success? It would sound to be really an ambitious program, above which architects choose to look beyond -inconsiderate of failures registered and prompt solutions to them.

The other initiative could be to have mobile clinics done by major health centers monthly. However, this could call for more funding from government to cover allowances, and mobility of personnel and medical equipment.

As a point of urgency, health officials and any level could take the initiative to look out for organizations with related programs as malaria, HIV/AIDS, family planning, immunization, women health or reproductive health - to partner with in having services brought down to the ministry and later down to the grassroots people.

It is not an insult to the health ministry, but rather a show of deep concern in reiterating statements others have made that the ministry of health is rotten. If the basic drug factory (Quality Chemicals) could stop manufacturing drugs, because the ministry of health had not made any orders: what better word would we say to describe its irresponsible actions -aware that health is pivotal to development or for every sense of leadership and management success.

The idea of setting up village health teams under the district health services -to act as village center one was great, but such teams would need more specialized training than they got in preventive health, patient or client care and confidence building to manage the health care challenges -organized at least annually by the ministry of health and its partners.

While in town, the feeling is different with regard to water access. In town, usually water is either within the house or a meter away. In rural areas, it can be several meters or a kilometer away. And where is it is urgently needed, community members are forced to drink dirty swamp water or for other domestic-related use.

It is real suicide exposing oneself to typhoid or dysentery -yet no means to recovery, but the reality is true for rural villages in Iganga. It was not surprising just as never for health officials and political leaders, who pass-by a bridge of rotting garbage on their way to administrative offices -reading media reports that Iganga was poorest in hygiene and sanitation.

Preventive health programs need to be integral part of project life in rural areas -as more organizations -with relevant programs get encouraged to operate there. Believably, with acceptance of the realities on the ground and tireless lobbying by community leaders like Daudi Migereko, Busoga region could become an exact description of what he gave in the press -recently.

Perhaps, it was part of his job to report the way he did in preparation for 2011 elections or as part of the independence celebrations this year. Luckily or not, it is the same rural people -who keep them in power. Politicians like Migereko, have been in power for considerably along time supported by the same people.

Jacob Waiswa
Situation Health Analyst
www.situationhealthanalyst.blogspot.com