Pregnant women in rural Uganda often live quite far from the nearest health center — and lack access to transportation that can easily get them to a clinic when they’re ready to deliver a child.
And so, when they find themselves in labour, these women usually end up having to walk to the nearest clinic to seek medical attention. Sometimes, they even give birth on the walk over.
“By the time they reach the health center, they have delivered because of the long distance,” Kafuko Dorothy, a midwife in rural Uganda, told INSIDER. Those babies are classified as “BBA,” or born before arrival, she explained.
Kafuko is one of two midwives who run Lugasa HC III, a health center located in the Bbaale subdistrict of Kayunga, in central Uganda.
Each day, the two midwives handle eight to 10 births, and see an average of 22 additional patients for family planning and prenatal care services. Many of the patients have to walk up to 30 km (18.6 miles) to reach the health center, Kafuko said.
Here is an inside look at the clinic.
The Lugasa HC III is a health clinic in the rural Bbaale subdistrict of Kayunga, Uganda. It sees an average of 22 patients for family planning and prenatal services, as well as upwards of 10 births, each day.
The health center, which is located off of a dirt road, serves 60,000 people in the subdistrict. It has a staff of 18 people, including the two midwives and several motorcycle taxi (known as 'boda boda') drivers that are called upon to act as makeshift ambulances.
Lugasa is composed of three main buildings, including one where women give birth and undergo family planning procedures (pictured), one for consultations and another where vaccinations are given.
Kafuko Dorothy is one of two midwives who run the health center. Both of the midwives live on site, work seven days a week and don't take vacation. They each work long hours but complain little because, as Kafuko puts it, they were born 'to love and serve.'
The health center's walls are covered with posters containing important medical information. And of course, like many health clinics in Uganda, a framed picture of Ugandan President Yoweri Museveni also hangs on the wall.
The hospital often has multiple deliveries at the same time, but its maternity room only has two beds. The midwives often use the only other bed, located in a consultation room, and also put extra mattresses on benches for the additional women in labour.
The consultation room is also used as a surgery room when doctors from non-governmental organisations like Marie Stopes International are on-site. Those doctors perform tubal ligation (a sterilization procedure that entails tying the fallopian tubes) and insert intrauterine devices (IUDs).
When the NGO doctors are not on site, the midwives are able to offer limited family planning services, including condoms, birth control pills and Depo-Provera shots. They also have several appointments with women before birth, and several afterwards.
Prenatal appointments are particularly important at Lugasa, so that the midwives can determine if there will be any complications. For deliveries deemed dangerous, the midwives send the women to the referral hospital in their district, so that they can be assisted by doctors. As a result, the health center hasn't seen any maternal deaths, according to Kafuko.
Women often seek out family planning services after they have already had at least one child. The midwives aren't trained to insert IUDs immediately following birth, so women typically come back at least six weeks later to hear about their options.
The health center has run out of birth control pills, which means that women visiting the clinic only have the option of getting the Depo shot or condoms to prevent unwanted pregnancies when the NGO doctors are not around.
On this day, in the third building (the vaccination area), community health volunteers educate women about their family planning options. These women have come from across the subcounty, walking upwards of 30 km (18.6 miles) to get there.
The area surrounding the clinic is quite remote, and many of the patients don't have access to transportation. That's why, when they go into labour, they typically have to walk the entire distance to the health center. Some of those women end up giving birth on the way over, Kafuko said.
Lisa Ryan reported this story in Uganda as a press fellow of the UN Foundation.
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