Birth and death are natural processes of life, but both have become an unexpectedly regular part of the workday in Kampala. For example, last week I saw my first natural live birth which was unbelievable. But literally seconds after the baby was born, I heard another mother wailing at the top of her lungs from outside the open window of the labor ward. “It’s coming from the pediatric ward,” Paul said. “Someone’s lost her child.” He said it matter-of-factly and continued with his business, as did the nurses. In a country where more than one out of ten children never makes it to a fifth birthday, my shock was just their everyday.
Healthy baby boy delivered at Mengo, seconds old
And it’s not only children who lose their lives early. The New York Times ran a story just a couple weeks back on maternal mortality in Uganda. The article focused on a locally elected female politician who bled to death in her hospital bed trying to give birth after no one heeded her calls for help… for 12 hours. It is easy to point fingers but the problems are much bigger than simply neglect on behalf of the health staff. Health has not been the priority of the government, and that was made clear when they spent half a billion dollars purchasing fighter jets this spring. Additionally, the article mentions that the government is investing less and less into the health sector. International aid is to serve as a supplement, but the government has used it as a replacement.
Maybe this is why twins and the bearer of twins are given such high respect in Ugandan culture – double the life in a country where each life has far fewer guarantees of survival. In fact, once a couple has twins, the name of the parent changes. The woman is addressed as “nalongo” (the mother of twins) and the man becomes “ssalongo” (the father of twins). The Ugandan media actually had nicknamed President George W. Bush ssalongo since he has twin daughters.
Twins and their parents are given much respect
A brother of one of the hospital workers was admitted to our intensive HIV/AIDS treatment room, suffering from an HIV-related opportunistic infection known as PJP. He also had late stage liver disease. But neither the patient nor his family could afford money for further tests, and even if those costs were covered, there was not enough to pay for any type of medication or admission to the wards. “Sometimes you just have to tell the family to pray,” one of the doctors said matter-of-factly. Two weeks later, the man passed away. One week after that, the hospital worker had a baby girl of his own. “We lost one, and we gained one,” he said with a smile.
“What happens when you get old in the US?” the same co-worker asked me while we were on home-based outreach in the community. He didn’t let me answer before he went on to describe the apparently dreary fate of the elderly in Uganda. They have no income and social security is not well in place. Apparently people go to their NSSF account only to find that their savings fund have been used up by the government. People earn so little as it is which makes it difficult to save, especially sums that are to last for several years. It is considered shameful if the parent moves in with his or her children, especially with a daughter who is married. It is expected that your grandchild takes care of you, so if you don’t have any grandchildren it can be problematic, and many die having fallen through the holes of an already weak safety net. When I asked someone else in our car how they were going to prepare for old age, he laughed and said, “You just pray not to grow old.”
Birth and death are universal, but somehow it’s as if they’re a bigger part of life here. Maybe I’m just noticing it more since it’s so common. After all, Uganda has the second highest total fertility rate in the world with each woman averaging more than six children. At the same time, the life expectancy has barely cracked fifty years. Some of my co-workers jokingly lament – “I’ve only got 10 years left!” Despite the nature of their work and the nature of life in Uganda, everyone can let loose. Each day, tea and lunch at the hospital are almost exclusively set aside as times to be silly (and eat). The rooms fill with laughter, hand holding, high-fives, and hugging. Looking around, you wouldn’t know that we worked in an HIV/AIDS department within a Ugandan hospital, but it’s a great way for everyone to handle all of the emotional weight that comes with this work.
