There are various things horribly wrong in blaming Mbale health workers for the much-publicised maternal death of Cecilia Nambooze.
The first is that it ignores documented facts that show Nambooze died of a ruptured uterus and lack of blood for transfusion. Yes, there was no blood at Mbale Referral Hospital. Not a red drop. During an emergency, in a hospital, can you imagine this?
Why was there no blood? This is a question for Uganda’s health ministry. The ministry, after all, is ultimately responsible for blood in public hospitals. At least health ministries govern such things in functioning health systems.
Of course, Uganda’s system has been broken for so long that everyday people here are too used to paying for hospital supplies, from medicine to sutures to gloves. But, yes, governments normally ensure basic supplies like blood are in hospitals.
So when Ugandan media reports say that Nambooze died because sh300,000 was not given to Mblae hospital staff, that is dangerously misleading unless clarified that the money was for supplies needed to save Nambooze’s life.
Functioning health ministries also ensure hospitals employ skilled birth attendants. This is because about 15% of childbirths, anywhere in the world, lead to emergencies.
How many skilled attendants were at Mbale Hospital when Nambooze died? One. And that one obstetrician, according to documents, was saving another mother. Why not more than one? This is another question for Uganda’s health ministry. But
consider many of Uganda’s best doctors, poorly paid for their hospital duties,
are busy in private clinics to earn just a fraction of the salary of, say, a politician.
The other very disturbing aspect of this case is the shameful arrest of a Mbale doctor. Is this not like Uganda putting a giant gun to its own head?
Many health professionals can easily find work elsewhere, including in the West. Play the blame-game, and they will leave. And where will that leave Uganda’s dying mothers?
I watched my two children being born in a Canadian hospital. If my wife had died from negligence, I would want serious revenge. So health workers do need accountability. That is why developed countries like Canada have professional bodies, for self-regulation by peers, who understand issues better than outsiders, like the police.
The good news about Nambooze’s death is that it has led Uganda to a crossroads. We now know the plight of Uganda’s mothers. President Museveni even campaigned on this. He was right to do so. But change will never come without an honest look at the entire system.
In fact, two-thirds of maternal deaths in developing countries like Uganda are not from medical causes at all, but societal causes: delays in seeking, then getting to care-facilities.
Then one-third of maternal deaths occur when facilities don’t have resources they desperately need. This is why Nambooze died.
Does the health ministry need a revenue re-allotment? What about international donor revenue? It is about 30% of Uganda’s total budget.
So the ministry can bear down and do its job and offer health workers incentives, especially to go to Uganda’s underserviced, rural areas. So it can educate women. So it can help mothers move to skilled care.
This deeper reform is what will bring Uganda into 21st century maternal care. It is hard work. But anything less is deceptive. And Ugandans deserve better. Don’t they?