September 13

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John and Dayna in Uganda – Dayna’s perspective

Some of you have been asking for me to give my voice about what it’s like here and my perceptions. While we on our second road trip recently, I started to think about some of the harsh realities these people face on a day-to-day basis. So I went onto some websites to get some statistics, and will give you a bit of insight into what we’ve seen in rural areas.

There are 34.5 million people that live in Uganda, landlocked between Rwanda, Tanzania, Kenya, Sudan and the Democratic Republic of Congo. In an area roughly twice the size of Pennsylvania, it has three mountain ranges and several lakes, the largest of which is Lake Victoria, the second largest inland lake in the world. In fact, 1/5 of Uganda is either open water or swampland.

Ugandans are very religious- approximately 80% are some form of Christian, 17% are Muslim, and 3% “other”.

Uganda is highly populated. In fact, it has one of the highest fertility rates in the world, 7+ children per woman (more in that later). Moreover, the population has grown exponentially – in 1948, the population was 5 million, and in 1960, it was 9.5 million. The majority of people live in rural areas – according to 2010 statistics, 87% lived in rural areas, but the migration to cities may make this closer to 75-80%.

Approximately 50% of Uganda’s population is under 15 years of age, and 95% under 55 years old.

So what does this mean for Uganda’s population? Services, such as healthcare and education haven’t kept up. In 2009, only 3.2% of GDP was spent on education. In that year, the average school-life expectancy (how long children stay in school) was 11 years old, and only 67% of the population could read and write. Sadly, when you dig deeper, of that 67%, 77% of the males, and only 58% of females could read and write.

While no statistics showed urban vs. rural, I would expect these numbers are vastly lower for the rural population, considering what we saw on our travels. In conversations we have had with Ugandans, you don’t send your children to public schools unless you have to, as the quality is so poor.

The statistics for healthcare are also very dismal. Only 8.2% of GDP was spent on healthcare in 2009. The top 15 causes of death in 2010 were:
– HIV/AIDS: 18%
– Influenza/ Pneumonia: 11%
– Diarrheal Diseases: 10%
– Malaria: 9%
– Stroke: 4%
– Low Birth Weight: 4%
– Coronary Artery Disease: 4%
– Birth Trauma: 3.5%
– Violence: 3%
– Tuberculosis: 2.5%
– Other Injuries: 2.5%
– Traffic Accidents: 2.2%
– Pertussis: 1.75%
– Maternal issues: 1.75%
– Diabetes: 1.6%

I found this fascinating (and incredibly sad) as so many of these causes of death are infectious diseases or due to poor pre-natal, ante-natal and post-natal care. By contrast, of the top causes of death in the U.S., chronic diseases account for 10 of the top 15 (heart disease, cancer, chronic lung disease and stroke are the top 4).

As we went through our field trips, it occurred to me that changing these health issues was so hard because of the way the population was spread throughout small villages. This limits access to care.

Additionally, the religious and cultural beliefs promote a woman having babies continually. Women in rural areas give birth to an average of 7.8 children, while urban women give birth to 3.9 children. When we spoke to the doctor at one of the Marie Stopes Outreach we attended this week, he estimated that most of the women he saw had had 10 children by the time they were 35!

We also saw that most of the women do all of the cooking, water and wood/charcoal collection, and the majority of farming. Not to say that men don’t contribute, but the women do the brunt of the work, to be sure. I felt like we were in the 1800s before the industrial revolution in many ways.

I know this is very depressing. Hopefully you are all thanking your lucky stars for our healthcare system and way of life about now (as John and I do every day!). Before you go drink your sorrows, know that there are rays of hope.

The Marie Stopes clinic we visited this week sees 1000 women a month (and a few men) for family planning services. The clinic director said they are working with tribal and religious leaders to get buy-in for family planning services, and they do their own outreach in addition to the MS Outreach team for the area.

Speaking of the MS Outreach, these hard working people saw least 60 women on the day we visited! It was amazing.

When you think that there are 15 Marie Stopes Clinics, 12 Marie Stopes Outreach teams, and 450 Blue Star clinics (Marie Stopes partners) throughout Uganda that counsel patients about family planning, I think they, and other organizations here in Uganda, are making a dent. I was so happy to hear the doctor we spoke with at the Outreach tell me that in villages where they have provided services to for a while, they are now seeing younger women coming in for long term family planning, and older women coming in for permanent solutions. That is REAL progress.

The Marie Stopes program also lets people buy low cost vouchers so that women can go to any provider for care. This assists in making sure that women can get pre-, ante- and post-natal care to reduce baby and maternal death. We saw women pulling out their vouchers at the outreach and at clinics. It was heartening to see that the program is working.

You’re probably thinking that I’m the one working with Marie Stopes. I do feel like I’m part of the team, and once you see these folks in action, it’s pretty impressive. So thanks for indulging my big Marie Stopes plug!

Know that most of the people we met seem happy, are friendly, and smile. The kids must think spotting a rare Muzunga (white person) is good luck- they all call out to us, wave and smile! More on the people we’ve encountered in future emails.