"When I can't treat my patients because the dispensary doesn't have drugs, it's embarrassing. Even when they can't afford it, I tell them to go buy in the shops because I can't tell them do nothing."
During the two months before the winter break, our crew focused on establishing storylines that depicted how the Right to Health is being voiced in northern Uganda. Over the past few weeks, however, we decided to take a step back in the narrative and shift our attention towards conveying the condition of medical services in government health centers. We toured 3 different levels of care units whose coverage ranged from the district to the parish (about 5 villages). During our visits, we didn't stumble across anything surprising on the surface. Graphically, each center conjured the cliche of African medical staff attempting to work wonders in the midst of empty dispensaries and labs without reagents. Had our film team left the microphone off, we could have easily walked away from these clinical excursions simply preserving the prosaic portrait of the paralytic physician in rural Uganda. But the stories that we actually captured on camera were not motionless; rather, the clinical officers were restless, doing whatever they could to spite doing nothing.
Celestino, Gulu district's public health educator and a medical supervisor at a sub-county health center, reported that he sends more than 50% of his patients outside his facility to look for oral antibiotics. He explained that over the past year drug shortages have worsen as a result of the Ministry of Health reverting back to an old strategy of medication and supply distribution, the "push system." In this scheme, drugs are dispersed from the National Medical Store to health centers every other month based on estimates of what types of cases are expected to be seen during a given period. Health centers are not able to request for medications (the "pull system") or use emergency funds to purchase drugs when they run out. Besides drugs commonly being delivered in inadequate numbers, scheduled delivery dates are often skipped. All of this, plus a large lack funding to the health sector mixed with some corruption, creates the situation where Celestino is forced to send patients away from his facility with only a piece of paper in their hands.
In the US, it sounds completely reasonable that a patient go see a doctor, get a prescription, and then run to a pharmacy to buy the medication. Though common practice throughout Uganda as well, the act of asking a patient to purchase drugs at a private dispensary here often carries the weight of demanding an impoverished subsistence farmer to find funds that are likely nowhere to be found. Celestino tells us that he is embarrassed to be unable to fulfill his role in providing the Right to Health, but he does not stay silent about the problems nor neglect to inform his patients where they can find treatment for a price. He continually files reports to his superiors about the inadequate provisions in his health center, and even though it is rare for anything to be done. The clinical officer is also one of the many believers that patients who become aware of their rights will subsequently become empowered to demand for better services. On camera, he cited the multiple local committees that community members could in theory use to voice their complaints, but after the interview, he admitted to being a little uncertain of his suggestions and asked us what we thought patients ought to do to call for change. We replied that we don't know, but that's why we are making this movie, to learn how others are doing it.
Throughout my stay in Uganda, I have been reminded on multiple occasions that I come from a country where health care is not a right and that it's strange for me to have to come all the way to Uganda to find it. Standing on the steps of his health center, Celestino jogged my memory once again. "It is very hard for me to understand, America goes to tell other countries about protecting rights, but you don't even take care of the most fundamental right. People need health care to live, so if you don't provide it for them, then you don't protect the right to life. Your system is very strange to me."