On Tuesday, after a bumpy four hour drive along the countryside, we arrived in the Lyantonde District Hospital. Lyantonde is a small, rural district of 74,000 people, about 200 km from Kampala. Dr. Obbo, the Medical Superintendent, was one of two doctors at the hospital, which serves about 250 people a day. Two other doctors were supposed to be on staff, but they have been on “study leave” for years. There are five Clinical Officers, which include midwives and locally trained nurses, that also work at the hospital. Dr. Obbo has often tried to fill vacancies for health care professionals, particularly positions for a surgeon and an ob/gyn, but has received no applications each time. Retaining staff is also particularly difficult.
Most of the residents of the district are either subsistence farmers or cattle ranchers. Malaria is the number one cause of death. Lyantonde also has a particularly high rate of HIV/AIDS. It is located on the transport corridor between Kenya, Uganda and the Democratic Republic of Congo, where the trucking industry has attracted many commercial sex workers. The District Hospital has been a pioneer in the region, working to reduce stigma and barriers to testing and treatment for HIV against all people, including commercial sex workers.
When funding and resources were more available, two community health workers would visit the local bars one night weekly, providing sex workers there with testing, counseling and condoms and treatment for HIV and other STIs. The health workers had reached and monitored 268 sex workers in five months. More recently, resources have been limited, and the weekly trips to provide health information and support for some of the most stigmatized women in the community has come to a halt. The hospital is hoping to revive the program soon.
Dr. Obbo also spoke about widespread domestic violence in the community. He described treating an average of one woman per week that had been battered by her significant other. Domestic violence is not taken as seriously as it should in these communities. The police infrastructure does not provide protection, and women are often coerced by family or socioeconomic pressures to return to men that abuse them. Dr. Obbo’s own sister had been abused by her husband and returned to him. He and I both hope to see more community engagement and advocacy for a reduction in these crimes against women.
(For more about the trip to Lyantonde Hosptial, see Neil Chawla’s post on Health Rights Advocate.)