The cold, bare, concrete floors, rows of basic metal-framed beds and thin mattresses with waxy sheets of fabric used as covers or blankets, the buzz of flies and mosquitoes as they come through the open windows, and the cries of unsettled babies echoing down the damp, unlit corridors. As I walked through the maternity unit I felt a wrench deep in my gut: “The odds are against you from the start…”
The maternity unit was part of a district hospital in a poor town in Central Uganda. As part of our time visiting our partner school in the town of Kamuli, we had asked permission to visit the hospital and see the conditions in which the doctors and nurses were working. Uganda’s Government is notoriously corrupt and it is blatantly obvious to all who spend any time in the country that very little Government funding ever reaches the service users. For a country whose total GDP sits at $50 billion, it is hard to see where any of that money actually is in a place like Kamuli.
The fifth Millennium Development Goal aimed to reduce the maternal mortality ratio by 75% between 1990 and 2015. In Uganda, maternal mortality remains high at 440 maternal deaths per 100,000 live births. For every maternal death in Uganda, at least six survive with chronic and debilitating ill health. However, data on maternal morbidity in Uganda is limited as 62% off women are delivering outside of health facilities. Uganda was ranked 29th country globally with the highest under-5 deaths and nearly 21% of under-5 deaths occurred during the neonatal period. In 2009 Uganda also experienced over 38,000 stillbirths. Socioeconomic status is a key determinant of survival for children in Uganda. Under-5 children in the lowest wealth category in Uganda are nearly 1.6 times more likely to die than those in the highest. Uganda is one of ten countries globally which contribute to the highest Maternal, Newborn and Child Mortality rate in the world. (Information taken from World Health Organisation)
Walking around the hospital in the scorching heat of the equatorial sunshine Prossy, one of the senior nurses, talked us through each area and we were told about various costs of beds and treatments. The UK’s ‘free at the point of delivery’ National Health Service was a million miles away from this. As we walked around the maternity ward we were told that women who could not pay for their bed had to sleep on a thin mattress on the floor. Women who have just brought life into the world – forced to sleep on the floor as they do not have any money for a bed. As we talked with women in the post-natal ward and saw their tiny newborn bundles, wrapped in layers of fabric to keep them warm, it was clear many of them were in great amounts of pain. Pain relief is a cost too far. Even worse were the women in the post-natal ward with no tiny bundles wrapped up next to them. That pain is too much to even consider.
As we stood in the corridor next to a set of plastic refuse bins with increasingly alarming signs attached to them, ending with a sign for disposal of amputated limbs, Prossy informed us that the woman in the labour ward had just given birth and there had been complications. We listened and waited for that wonderful, full-lunged cry of a newborn. We waited and waited as what felt like minutes passed. I could feel my heart sinking further and the tears filling my eyes as we waited. Then we heard it. The tiniest yet clearest whimper. The big cry wasn’t going to come but, for that moment, that tiny sound was enough.
At the same time, 6,600 miles away in Glasgow, Scotland, a friend of mine was giving birth in a labour ward in a National Health Service hospital, surrounded by every technology needed to ensure her little girl would be given every chance of surviving those first terrifying moments in our world.
Two babies. Two mothers. 6,600 miles apart. Two very different chances. The latitude lottery of birth that exists in our world was so frighteningly clear within those moments. And so startlingly unfair.