The (not-so) secret suffering of health workers in Uganda

I first heard about it during our two-week Global Health Corps training at Yale. I was talking to some of the other fellows during a small group discussion – a nurse from Uganda, another from Rwanda, a doctor from Malawi.

The Ugandan nurse casually mentioned working for several months without pay. The Rwandan nurse lamented the constant mistreatment of nursing staff by superiors at work. Sure enough, they all reported similar stories about the laughably poor working conditions they endured as health workers in their respective countries.

Laughable, of course, if you think working for months without pay is funny. Or if being reprimanded by a supervisor for reacting ‘too emotionally’ to your first patient death is funny. Or if lacking even the most basic amenities at your work place gives you a laugh.

Flash forward to my first week as a fellow at Save the Mothers in Uganda. On a visit to the overflowing maternity ward of the national referral hospital, I’m standing outside a dark, door-less cement closet with a hole in the floor being told that this is the staff washroom. (You can be certain the patient washrooms are even worse). Casually bemoaning the lack of a water cooler or tea kettle for staff on the ward, the consulting ob/gyn who we were visiting asked us to bring her back a Coke Zero on our lunch break. Of course, she herself wouldn’t be taking any breaks during her 24-hour shift. There were simply too many emergencies to attend to among the masses of laboring women filling the beds, benches, and floors of the ward.

I’m standing outside a dark, door-less cement closet with a hole in the floor being told that this is the staff washroom.

On a visit to a district hospital, our team arrived only to find that two midwives had been taken away in handcuffs the previous night after a mother had perished in childbirth. This is an unfortunately, all too common occurrence in Uganda – both the death and the arrests. Though, technically speaking, this is not legal, many health workers don’t know their rights and are thus not empowered to speak up. So, instead of being counseled and supported through the trauma of losing a patient, these midwives were carted off to the local police station.

I’m not exaggerating when I say that at every single hospital I’ve visited with Save the Mothers’ Mother Baby Friendly Hospital Initiative, health workers have talked about strenuous 12+ hour shifts attending to dangerously high numbers of mothers and newborns (think, 1 nurse/midwife to 50 patients), without so much as a water break.

On top of these wholly demoralizing circumstances, health workers at hospitals across Uganda are dealing with a severe shortage of basic supplies like gauze, gloves, and sutures, making it difficult to do their jobs safely and effectively. Is it any wonder then, why health workers in Uganda get a really bad rap for being unfriendly, disrespectful, and even abusive to patients? They endure traumatizing, disempowering, and downright dangerous working conditions on a daily basis.

Is it any wonder why health workers in Uganda get a really bad rap for being unfriendly, disrespectful, and even abusive to patients?

And still, given these odds, you’d never believe how passionate and committed these women and men are to the call of duty. At a recent event to launch a new hospital into the Mother Baby Friendly Hospital Initiative, the midwives and maternity ward nurses sang to the audience about the importance of keeping mothers alive and performed a theatrical skit depicting a ‘day-in-the-life’ of a midwife in the hospital’s bustling maternity ward. It was a powerful demonstration that they care deeply about the fate of mothers in Uganda, and work hard to ensure their survival, despite the cards stacked against them.

Health workers have been called the “backbone of the health system,” and for good reason. Without them, there would be no health care for millions of people around the world. But, when it comes to the health systems strengthening tactics currently prevailing worldwide – rather than focus solely on churning out more health workers, why not shift the focus to ensuring that health workers can thrive in their current workplaces? Advocating for increased national allocations for the health sector, strengthening medical supply chains, and investing heavily in clinical and other skills training are a few key steps in the right direction.

I want more moms in Uganda to survive childbirth. And I want them to be well cared for in health facilities, so that they’ll want to deliver there. Which is exactly why I want motivated, well-trained, fully-equipped, and fairly-paid health workers to become a top priority in this country. Let’s strengthen the health system from the inside-out, starting with its greatest assets.