A Dog’s Life for Mothers in Northern Ugandan Refugee Camps

(January 27, 2004) A pregnant woman must visit a maternity facility for medical check-ups at least three times in her nine months of pregnancy, and one or two times after delivery. Not so for the woman in the congested displaced people’s camp in northern Uganda with few health centres nearby.

“We have to walk ten kilometers from here to Gulu Hospital for antenatal check-ups, it is tiresome and you do not want to experience it for the second time,” says Catherine Achiro, 31, a mother of five from Awer camp.

When they go into labor, most women first go to traditional birth attendants (TBAs) before thinking of going to the hospital labor wards.

At Unyama camp there is only one Grade II health center that serves 16,000 people. About six miles outside Gulu town, there is a Grade II health center but no maternity ward.

“These facilities are temporary,” says Ngeca Esau Ojwang, who is in charge of the emergency unit.

Although the health center distributes free birth control pills and condoms, and offers anti-STI treatment, it does not handle deliveries.

“The TBAs help most of the women to deliver their babies,” says Ojwang, adding that there are 28 TBAs in the whole of Paicho sub-county where Unyama camp falls.

Most of the women interviewed prefer giving birth in their “makeshift” grass-thatched huts.

“Even if you went to the health centers, you would neither get drugs nor health workers to attend to you during labor,” reasons Grace Lanyero, 26, a mother of five, all born at home.

“During pregnancy we walk over six miles to Gulu Hospital for maternity check-ups…but when it comes to deliveries, I am always assisted at home by a neighbor,” she adds.

Unfortunately, some mothers die of complications during or after labor. In all the health centers, there is no equipment and personnel in case of caesarian deliveries.

“The only camp where we will soon be able to perform caesarian deliveries is Anaka in Nwoya county,” says Dr. Paul Onek, the district director of health services. Operating theatres are also being put up in other health centers like Kilak and Omoro counties.

But for the moment, any patient requiring surgery has to be transported several miles across risky village roads to Lacor or Gulu hospital by bicycle, motorcycle or by car.

“We have an ambulance but sometimes the army says the road is not secure and it is not surprising that we lose many mothers,” says Onek.

“Because of insecurity, there are few health workers,” he adds.

For example, in the camp at Pabbo that serves 60,000 people, there is only one midwife for an average of 3,120 deliveries each year.

“Generally, there is an acute shortage of midwives,” admits Onek. “The health workers carry out only 15% of the deliveries. Some women deliver on their own, while the majority are delivered by TBAs.”

The elderly TBAs are medically trained and experienced, but often lack equipment such as gloves.

The maternal mortality rate in Gulu is one of the highest in Uganda at 700 out of 100,000 deliveries. This is higher than the national ratio of 506:100,000.

“The health of the mother as she gets pregnant and carries the pregnancy is usually very poor,” says Onek.

The infant mortality rate is 172:1000 compared to the national infant mortality rate of 88 out of 1,000 live births.

After a woman has delivered, she is often dehydrated and weak and another dilemma sets in: That of how to look after the baby, especially feeding it as it grows. Nutritious food is not readily available because of the Kony war.

Due to poor feeding most infants are susceptible to diseases like yellow fever, malaria, diarrhea, cough, scabies and intestinal worms, making them stunted, emaciated and weak.

“We do not have food to feed the children,” laments 48-year old Sabina Ajok. Her neighbor, Margaret Ato, 34, has a three-month old daughter but because she is dehydrated, the milk from her flat breasts is not enough for her child.

“I am now feeding the baby on millet porridge,” says the mother of eight, herself malnourished.

“My child falls sick every now and then. Since she was three weeks, she has been having diarrhea,” says Santa Anek, also from Unyama, as she shows me Barbara Acora, her thin two-year old daughter.

Jennifer Adong says Francis Okello, her two-year-old son has a similar disease. “His stomach is swollen and he suffers from recurring diarrhea which makes him cry. Last year he was admitted to Lacor Hospital, for a week but the disease has persisted.”

According to medical officials, a number of the babies die because of poor feeding, and insufficient milk from their mother’s breasts, while others die due to the lack of medical care.

“We are having all these problems because of the insecurity,” says Dr. Onek.

“Unless peace is restored to northern Uganda, things might get worse for mothers and their children.”