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The cost of containing COVID 19 in Uganda

In the best of times, some 16 Ugandan women die every day from pregnancy related problems.  They bleed to death, they get severe infections following delivery or a lost pregnancy, or they get pregnancy related convulsions leading to death. Now, these women no doubt try to reach healthcare, and in many cases they actually die in a health facility, having got there too late to be helped.

Women aside, the country has a wretched record for deaths of newborns and children under five years. Over the last several years, Uganda has also experienced an increase in the number of people who need emergency care for conditions such as high blood pressure, diabetes, heart disease, kidney disease, and complications of cancers. On any regular sunny day in Uganda, tens of people die of these conditions, many of them easily prevented or possible to treat.

Then came COVID-19. Because of the experiences of countries such as China, Spain, Italy, and more recently the UK and USA, Uganda has been primed to expect decimation by the virus. Our guard is as high as it can go. We have done everything to keep the virus at bay. Eight weeks and counting since the first person was diagnosed with COVID 19 in the country, and we still have no registered deaths! That is quite the record! Ugandans watch the counts daily, we compare our record with those of neighboring countries, and we swell with pride. This is especially so for those Ugandans who are able to work from home, who have not spent one day hungry, and who go on social media to share recipes, and complain about the boredom of the lockdown.

Now, let us examine the wider picture. What has happened to all those people who would have needed emergency medical care under normal circumstances? Where are all those mothers who would ordinarily call the boda guy, now unavailable for passengers, to rush their convulsing baby to the clinic, now closed? Where is that diabetic patient who wakes up in the night sweating and shaking, and they know that if they do not get to the hospital right away, they might not see dawn? Where is that mother, expecting her first baby, who wakes up in a pool of blood, and she knows this is not normal?

Our media channels have carried stories of mothers dying in childbirth because they did not get to hospital in time. But a baby dying of severe malaria does not make news. A 60 year old farmer with diabetes dying in his house does not attract media attention. An asthmatic primary school teacher who labors all night to breath, and dies on arrival at the health center the following morning, is not headlines worthy. In a very real sense, most of these people are dying because they could not access medical care due to the lockdown. They are as much victims of COVID 19 as if they had actually died of the virus.

What Ugandans need to be tracking, instead of the very narrow attention paid to the people testing positive for the coronavirus, is to pay attention to all those suffering, and dying, as a result of the pandemic. If we were losing so many people under normal conditions, how much more now? This will help us to plan better, and to hopefully prevent the needless deaths that are occurring in our communities during lockdown conditions. It will mean that we plan emergency transport mindful of these possibilities. We should also be concerned that a fairly large proportion of poor people are not eating enough, and malnutrition is likely to go up. Routine immunizations have stalled, mostly because mothers cannot travel on foot to health facilities to take babies for their shots. Months down the road, we might experience epidemics of diseases like measles. The health cost of the pandemic in Uganda is far greater than the cost of containing the coronavirus. The faster we wake up to this reality the better we shall plan. The more humble we shall be concerning our zero COVID 19 deaths.

Written by Dr. Olive C. Kobusingye

 Dr. Kobusingye is a Senior Research Fellow PI, Trauma, Injury, and Disability Makerere University School of Public Health. She is also  a Distinguished Fellow, The George Institute for Global Health, Australia and Board Chair, The Road Traffic Injuries Research Network.