Anna Eisenstein: The End of the World

In this photo, what do you see?

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Nestled in those hills, there are villages, homes, people. Mostly, they work the land to grow enough food to survive, selling a few of their sweet potatoes whenever they need to buy another item. If they need something, they must sell something. They are some of the world’s poorest of the poor.  I took this photo from their health center.

The Ruhija health center is the facility providing care for the people that live within these hills — yes, this one health center is for all the hills that stretch as far as the eye can see. It is a level III health center within Uganda’s public health system, which means it provides an outpatient clinic and a maternity ward for the entire sub-county.  Although every parish is supposed to have a health center II for addressing common diseases and offering antenatal care, many parishes do not. (The parish is the unit beneath the sub-county in Uganda’s land organization scheme – think states/counties in the United States.) Here in Ruhija, getting to the health center means climbing through the mountains, maybe even for days. Can you imagine making such a trip for antenatal care, while heavily pregnant? Or if your family member was too sick to hike, carrying them in a basket that stretched between you and another person, hanging from poles that rested on your shoulders?

I had the opportunity to travel to Ruhija to visit some of Mbarara University’s students from various health professions. They were doing a community placement there, focusing on an antenatal care intervention. They traveled out of the health center and into the communities periodically, coordinating with “village health teams” to provide antenatal education and care on designated days. Members of the village health teams are volunteers from the community who receive some basic health training so that they are able to advise locals and refer them to the health centers. They are also supposed to distribute medicines, but the health teams are usually not provided even the most basic drugs due to government stock-outs.

The students’ contribution is noble, and they helped people. But the community’s needs are so much deeper than what a small group of students can provide. What about the ones who need antenatal care two months from now, who are too far from the health center to come for it? When we first got out of the car, I was stunned by a breathtaking view. But taking in a bit of the meaning of those hills for the people who live in them changed my perspective. This vista is not just a pretty glimpse of natural beauty, but a powerful image for thinking about access to care.

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