The state of health centers in many developing countries is appalling. This is upsetting because it renders the recent global campaign to boost staffing in health facilities a non-starter. Some of the revelations at certain health centers are unbelievable. For example in Kassanda health center in Mubende district (located in Central Uganda), a woman who delivers is immediately transferred to another ward and "given space on the floor"! Such action is likely to cause dire consequences to both the mother and new-born.
Men women and children are admitted in the same ward. A health facility that resembles a concentration camp is a recipe for disaster. The shortage or total absence of drugs and sundries, broken-down ambulances, lack of water and power in the health facilities paint a grim picture of the situation in the health sector in Uganda, or a same situation in many developing countries.
Let me share a real story I experienced in a field early this year. During a monitoring visit for one of our programmes with Mr.Kasozi Dickson of Humanity Direct (a UK-based charity that bails out the most vulnerable children by offering them free life changing surgical operations, working with several hospitals in countries including Uganda, Tanzania and Somaliland where many families can't afford even basic medicine - so being able to afford an operation is out of the question where many delay seeking medical care until the condition worsens or get into debt they can never repay), in partnership with Global Healthcare and Education Initiative (GHEI-Uganda Chapter) giving out clothes and other items to vulnerable children, as well as medical equipments to the many rural health centres.
With such work and more so doing some investigations as a journalist, I came across a referral slip made by a pharmacy staff member referring a 32 year old woman to Directly Observed Therapy Short course (DOTS) health center. Looking at the symptoms circled on the slip, one could tell that this was certainly a pulmonary TB case. Weight loss, fatigue, chest pain, fever and cough with blood. We traced the referral to one of the district health centers where we found out that the women had indeed gone for further evaluation, she was checked, diagnosed, given medication and sent home. We were told by the health center staff that since the first visit, she had returned twice, each time sicker than before and would be sent home again, no TB! We decided to visit her at home where she lived with her husband, her in-laws, and two small children and one baby. We asked the district TB officer to join us so he could be able to follow-up later on.
When we arrived in her small house we were taken up in her room, she was sitting on a straw mat on the floor, baby on the breast, glassy eyes, and face flushed with fever. She repeated the same story that the health staff told us. She told us how disappointed, sad and scared she felt, she said she was getting worse by the minute and no one could help her. She said she wanted to go back to the health center but they didn't have any more money and no transportation. Each time she coughed, she hit on her chest to show us where it hurts. I will never forget the pain on her face, the sound of the shortness of her breath when she tried to tell us her story. I will never forget the fear I felt for the baby on her breast and her other two children and thinking that this woman, unless treated immediately, will soon die and leave these children orphans with nothing to make a go of life.
The end of the story is that the woman did have pulmonary TB and the last we heard was that the district officer was trying to get the children tested with the help of GHEI-Uganda, a local NGO working in the area to bail out vulnerable children from poor families by offering them free direct healthcare and medical services. So what wentwrong? Why did this woman seek care three times and still was sent home with a bag of antibiotics and vitamins? This is a very common story and it is happening every day, many times a day around the world, especially in higher TB burdened developing countries.
I shared the story because I truly believe we might not be able to reach our goal to zero the numbers of children dying of TB in our lifetime, let alone by the year 2030, if we do not take some drastic steps to address the real problems that are preventing us from doing a good job. We can have guidance and operational plans for TB in children; we can have the treatment algorithms. However, I strongly feel these will not help much, especially in limited resource setting where stories such as this are real unless we start by holding the governments accountable for the health and wellbeing of the populations under their jurisdictions.
Health is a right not a luxury, and so we can wholeheartedly lobby in our capacities, or advocate for the increase of the salaries of the health staff to motivate them to perform appropriately. Health staff in developing countries often do not get their salary for three to six months and may be up to 18 months like the case in Zimbabwe.
Strengthening the DOTS Programme. If we had a quality DOTS Programme, the health staff would have been able to accurately diagnose and successfully treat the mom in the story. They would have been able to prevent TB and the needless suffering of her children.
TB is a poverty disease, half of the children in developing countries go without meals and they are malnourished which makes them more vulnerable to TB. Addressing the nutritional needs of children is also of paramount importance. TB in a child that is already living with HIV/AIDS is a double heartbreak and so much more difficult to diagnose and treat. Unless we can diagnose and successfully teat the mother or the infected care giver, we will fail to diagnose and treat the child. The majority of the children get TB disease from a parent or a close relative.The longer the child is exposed to an infected caregiver the greater the risk of transition.
TB is very political and things are moving very slowly - we cannot afford to move slowly any more, we should not allow it. We need to step up very fast. What we should all see at the end of 2020 is not just the numbers, the statistics showing fewer deaths from TB among children, we should see children with happy and smiley faces, children free of TB . Where there is a will there is a way and I hope that collective voices will find that way.