Friday, November 26, 2010

HEPS, the Mortuary, and the Letter

On Tuesday, I took the bus down to Kampala for meetings with a right to health organization, called HEPS Uganda, as well as to pick up our infamous letter of support from the Ministry of Health. In the Lira District, where we hope to focus our documentary film, HEPS has implemented a novel approach to empower impoverished citizens to voice their needs for better medical services. The organization has introduced anonymous complaint boxes in government health facilities. The boxes are emptied every few months, at which time the NGO reviews the written concerns of patients with each individual health facility. Some of the more common complaints involve medical staff charging for services that are supposed to be free as well as mistreating patients while under their care. For vulnerable communities throughout Uganda, the little wooden repositories have provided a moderately successful forum to hold local health centers accountable for failing to provide adequate and appropriate services. In one district, hospital staff was arbitrarily charging female patients different prices for assistance during labor (often the price would be more for delivering a baby boy). Dozens of patients quietly protested this practice through the boxes, and HEPS then took up the case with the hospital and district health authorities who eventually put an end to the illegal scheme. Sometimes, however, the anonymous complaints only shift a problem to some other unsuspecting community. In another district, a handful of patients and their family members filled up little slips of paper with stories of a surgeon conducting operations while intoxicated. Their silent voices were heard; the district health office ended the doctor’s practice at the community hospital. But, these same hushed grievances also allowed the surgeon to be easily relocated to a health center in the neighboring district, where he is reported to be currently practicing with impunity. Sometimes too, hospitals and healthcare authorities will completely refuse to act on the issues raised by HEPS’s boxes. In these cases, the NGO doesn’t have much teeth other than to lobby for reform at the national level. I asked members of the organization if they encourage communities to file complaints through the human rights commission, and one of them responded, “No, we teach citizens about their rights so they can make demands at the level of the hospital, but we don’t want to raise their hopes and then have them be let down.” The staff had yet to hear of a successful right to health complaint filed through the commission. Hopefully, we’ll capture one on film.

When not in one of my meetings or running on errands around the capital, I tend to make the Yale office at Mulago a base camp for operations. On this visit, I was pleasantly surprised to find Michael Dewan doing the same thing. He happened to be in the capital attending a conference on how to enforce helmet use amongst boda boda drivers in Uganda. How he became interested in the topic, and came to attend the conference, is a long story that he plans to share on this blog. I’ll just say for now, he has discovered a lot of amazing details regarding the boda boda culture, and its curious relationship to Ugandan politics. As a result of his participation in the conference, Dewan has begun helping out with an injury prevention study run by the CDC. One of the study’s first questions is how many deaths secondary to boda boda accidents occur each year? Not a terribly difficult question to answer in theory, but hunting down the numbers from the various institutions responsible for keeping them is an audacious odyssey in and of itself. As part of this quest, Michael had scheduled a visit with the city mortuary, and I decided to tag along while waiting for my next meeting.

To get to the house of the dead, we took a circuitous route through new Mulago and down a back driveway to a nondescript brown building situated just outside the hospital’s side gate. Our guide was a young mortician, happy to help with the data crusade. Though the building bore no visible clues of the treasure that lay hidden within its walls, the harsh odor that greeted visitors 15 feet before its entrance left very little on the differential for what this place could be. With our heads quasi-bowed, in an attempt to minimize the necrotic air directly stimulating our olfactory bulbs, Michael and I followed the city’s plain clothed Charon through the morgue’s doorway. We then entered an atrium painted turquoise and decorated with stainless steal industrial-sized cabinets. Each metallic chest of drawers was 3 high by 3 across, like a tic-tac-toe board. From the front, they were reminiscent of some funky, modern Japanese hotel’s sleeping compartments that I saw once on the travel channel. Across the atrium, we entered a tiny office with a wooden table in the middle, which was bordered on two sides with a single chair each. A middle-aged police officer sat at one end, flipping through some papers, while our guide pointed to a large rectangular book in the center of the table and said, “Here.” At home, death moves from the body to a chart to a computer file. Here, if you’re lucky, it gets saved in a day planner. And even then, the cause often remains ambiguous on paper. Thus, as the mortician flipped through the registry’s pages, he noted to Dewan he would probably have to look through the police reports stored at individual stations around the city if he wanted to patch together an accurate number of annual boda boda related deaths. To give an example of how one of these reports looks, he turned to a faucet, now turned file bin, attached to the office’s back wall and pulled out a few flimsy white sheets of paper attached together. “You see, it says RTA, road traffic accident, but it doesn’t mention what kind. But, maybe they have the numbers at the stations.” The police officer in the room voiced agreement. Leaving the office, we got a brief tour of the rest of the facility, which was basically a large room with a handful of tables. On them, there were a number of RTA victims brought in that morning. We then observed an autopsy of a young woman who had succumbed to injuries received while riding on a bus that had flipped over on its side. The patient had died of a pulmonary embolism, which was facilitated by her multiple broken limbs. While a group of men draped in aprons were carrying out the whole procedure, the doctor was careful to record all the findings.

By the late afternoon on Thanksgiving day, I had a great reason to be thankful, we finally got the letter. The letter. It comes straight from the top of the Ministry of Health and clearly states that there are no objections to our research and film. After weeks of jumping through hoops, I sat outside the director general’s office, describing to his secretaries the various foods we eat on Turkey day, while he made the final edits to our green light papers. By the time I got them packed away safely in my bag, it was getting close to dark, which significantly increases the risk of experiencing a RTA during the 4 hour bus ride to Gulu. So, I decided to take the shorter ride out of town to Jinja for the evening, to celebrate the holiday with Dewan and some of his friends who have been volunteering as teachers there for over the past year. The meal was amazing, a real turkey that Michael purchased down the road. The ride back to Gulu the next day was another long adventure, and the letters have already begun their magic. We started filming in the Lira district with the Human Rights Commission today. But I’ll tell you more about that soon. Hope everyone had a wonderful Thanksgiving.

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