Olive Kobusingye

Surviving the COVID 19 pandemic: the view from a Ugandan surgeon and epidemiologist

Guest post by Dr. Olive Kobusingye

In managing the pandemic, Uganda seems to have checked many of the right boxes so far. Schools were closed, large gatherings banned, and some form of physical distancing adopted before Uganda registered its first case of COVID 19. The sole international airport was closed on March 23, 2020, a day after the first case was confirmed. Then followed a creeping lockdown – first stopping public transport, then private cars, and finally discouraging all non-essential movement, even on foot.

Tracing and quarantining contacts of those who test positive is ongoing, and seems to have yielded good results. At 79 positive tests and no deaths, Uganda has the lowest number of confirmed COVID 19 cases in the East African region. The majority of these cases have been discharged from hospital, having tested negative at least twice following treatment.

Some would say that Uganda has an unfair advantage – if repeated encounters with Ebola can be called advantageous. Between 2000 and 2014, Uganda experienced four Ebola epidemics, and learnt some useful lessons, so that physical distancing, movement restriction, and contact tracing are not new, at least among the public health community.

But behind this veneer of success is a less rosy story that needs to be told.  

Uganda has one of the largest government administrations per population in the world. For its 41 million people, the country has 80 ministers, 426 Members of Parliament, more than 400 salaried presidential advisors, and layer upon layer of bureaucracy from there down, including a special representative of the president in every one of the 134 districts, called the Resident District Commissioner (RDC). The minimum academic qualification for this representative is a Senior Four certificate (Ordinary Level certificate, two years shy of a high school diploma).

A Local Defence Unit officer whips a man in downtown Kampala.
Credit: Alex Esagala, Monitor Publications

It was to this rather unwieldy structure that the pandemic containment task fell, once it was confirmed that the virus had entered the country.  A national taskforce was hastily put together, headed by a military general. The Ministry of Health which had seemingly wasted 2 months of lead-time jumped into action – barely funded, understaffed, poorly equipped, and heading into a hurricane with no roof over their heads. The President saw fit to entrust the district level management and substantial budget for the pandemic into the hands of RDCs – beginning with the authority to determine who could move, and what patients could benefit from the scarce ambulances.

Within a couple of days of the near-total lockdown it became apparent that most Ugandans were unprepared for the extreme limits on movement. Only vehicles carrying essential personnel and goods were allowed on the roads. Bodaboda (motor cycle taxi) riders were barred from carrying passengers. Movement permits in the form of stickers were issued by the Ministry of Works & Transport. Before the genuine ones were done being distributed, counterfeit ones hit the roads.

Initially, anyone needing to go to hospital was required to call the RDC for permission to use a private car, or for an ambulance to pick them up. The RDCs were totally unprepared for the avalanche of calls, and most either went unheeded, or the promised service was never sent. (Later this was relaxed to enable different modes of transportation to take patients to hospitals.) 

There was instant outcry about the lack of transport from essential workers – health workers, market vendors, and utility services personnel. Doctors were arrested and held at Police Stations because they did not possess the right stickers. Informal workers, such as roadside vendors, cleaners, and porters in markets, were constantly harassed for leaving their homes to come to trading centers, and they in turn complained that if they stayed at home they and their families would starve.

Security agents ruthlessly enforced the lockdown, and in two separate, widely reported incidents, two bodaboda riders were shot, one fatally, for disobeying the lockdown regulations. Many essential workers stayed home for fear of violence at the hands of the security agents. A Member of Parliament found distributing food to poor families was violently arrested and imprisoned. Patients could not get to hospitals, and some died in the community. During the first two weeks of the lockdown at least seven women were reported to have died in childbirth, and another two had still births, having failed to access care.

While all the drama ensued on the roads and in the villages, the really big story was unfolding behind the closed doors of Parliament and would soon spill out into the media, houses and slums. MPs sat – one would hope safely distanced – and passed an emergency supplementary budget. A tidy sum of €600 million was to be borrowed from the European Union by the Executive, and the Legislature quickly obliged. Then the splitting of the money began.

An LDU Officer runs after a man as they disperse people in town, 26th March.
Credit: Alex Esagala, Monitor Publications

First off, €100 million went to the President’s household as classified expenditure, meaning that it was not open to scrutiny. The President did not have to explain to anyone, ever, what he did with the money. The remainder was shared between the Ministry of Health, the Office of the Prime Minister, Ministry of Defence, the President’s Office, districts, and the RDCs. The story would probably have been hushed up completely, had Parliament not thrown in €5000 for each MP, ostensibly to help with ‘community sensitization’.

Once the media caught wind of the story, things started to unravel. Here was starvation, and the people’s representatives were, it appeared, climbing in bed with the Executive to pocket the bulk of the money borrowed on their behalf. The equally important story of doctors and nurses working without Personal Protective Equipment (PPE) was drowned out in the noise around the money.

The relief food procurement ran into problems over corruption. Some senior officers were arrested and charged with fraud. When the distribution did get under way, some of the food was found to be expired, or otherwise of such poor quality as to be unfit for human consumption. Weeks into the exercise, only a minority of those targeted by the relief have so much as seen the food trucks.

If corruption and an inefficient government were the only problems, Uganda would probably scrape through just fine. But the majority of Ugandans are also too poor to comply with the measures being advocated to fight COVID 19. 78% of the population is under 30, and youth unemployment is above 50%. With an average per capita income of US$800, a large proportion of urban Ugandans have to find food daily, and they could not practice social distancing even if they wanted to. It is hard to ‘stay home’ when home is a one-room dwelling that houses at least five people, with the doorway to the adjacent home only a couple of meters away.

One in every three Ugandan under 5s is malnourished to the point of stunting, and one third of women in child bearing age are anemic. The lockdown’s extreme conditions have the potential to tip many vulnerable people into acute malnutrition. For now, most are simply trying to survive the day, and the lockdown. They are not even thinking about the general election, just ten months away. But if they make it there, at least there might be something coming to them during the campaigns.

Dr Olive Kobusingye is a Distinguished Fellow at the George Institute for Global Health and an A&E surgeon and Injury Epidemiologist at Makerere University College of Health Sciences, Kampala, Uganda. She is the author of The Patient.

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Comments

30 Responses to “Surviving the COVID 19 pandemic: the view from a Ugandan surgeon and epidemiologist”
  1. This story makes me sad, and seems to show that 1) the stringent measures also lead to death, perhaps in different categories than for COVID-19, and 2) the aparent need for extreme measures plays in the hands of governments who do not care for their citizens, especially vulnerable groups, almost strengthens poor governance performance. The question that keeps me busy – what ‘activist’ forces are emerging in this situation that could be supported? What is OXFAM doing to imagine interational solidarity in this crisis?

    • Olive Kobusingye

      Thank you Lucia. Indeed, it is a difficult situation, because while it is a good thing that government takes charge and is in control, it does mean that ‘activist forces’ have very little space in which to intervene. All assistance must be channeled through the National Task Force, with all its inefficiencies and questionable transparency. Access to communities is very limited, and because of movement restrictions, people’s ability to organise is equally limited. Clearly, there is great need for organic community structures that can function in such situations. Food security is a badly neglected area, and we are paying the price.

    • Nkole

      You may criticise the approach used to combat the spread of covif-19, but the fact is that many Souls were saved.

      You have not mentioned countries where people were being charged up to £1000 or imprisoned for breaking similar guidelines.

      Law enforcement is conducted differently in different countries.

    • martin

      I thought this is a sovereign government and greedy people are just greedy. Let’s not bring Kenya into our most greed. It’s been there only that our eyes were open the other day

    • Olive Kobusingye

      I am glad you find it helpful, thank you. Hopefully we learn some lessons from this painful experience, so that we can change the narrative moving forward. Fingers crossed – this teachable moment could be easily wasted!

  2. Caroline

    “First off, €100 million went to the President’s household as classified expenditure, meaning that it was not open to scrutiny.” Wow, thank you for this post. I had an inkling of what might be happening in such contexts but not to this extent.

  3. “If corruption and an inefficient government were the only problems, Uganda would probably scrape through just fine. But the majority of Ugandans are also too poor to comply with the measures being advocated to fight COVID 19. ”

    This view/disclaimer/point is all too true for many African countries, and explains why countries like Ghana ‘are doing ok’ by many standards and yet, the realities or the everyday person is far from it.
    The Ugandan story is heartbreaking but also a collective tale for several others – and it just need not be that any longer.
    Now, in the past, and in the future, this makes me ask the question, aid for development or aid for geopolitical reasons? I dont mind either but just be upfront about it and let people actually know where they stand and what they can expect to get from the packages delivered.

  4. KIGOZI AUGUSTINE DARLINGTONS

    In Uganda everything is possible
    If the action to be done protects the presidential seat then no-matter the consequences that thing will be done. If you love the president then your acts are also right but if you are from the opposition like #Zaake then you are a against your country

  5. Robert Migadde

    The motto of Uganda is ‘For God and my Country’ Pro Deo et Patria. If we really love who we are, what we do and our destiny; we just need to do the needful to keep safe.
    The fact remains that it is through joint efforts that we shall be able to kick Covid 19 out of the country and the globe at large.
    Prayer remains key in all this.

  6. Mary Njeri

    Thanks Dr. Olive. A very sad but educative piece. The numbers are especially scary for me, 426 MPS, 400 presidential advisors, 80 ministers and 134 RDCs. All these mean serious expenditure

  7. Henry

    Sad facts and a true representation of “leaders becoming misleaders” saying. For starters, after the public became highly irritated about the a portion given to MPs as COVID 19 funds, the president advised that this was irregular during this period. This was seen as backstabbing of the MPs and todate, a spirited fight exists, led by the speaker of parliament which to her is an attack on legislature “independence” (MP Robert Kyagulanyi earlier had called it a bribe that was included in the budget to hood wink them into passing the supplementary budget.)

  8. Joseph

    Very shocking, but not surprising! The COVID-19 is the current national project, just like the previous term limit, age limit, the Desert Locust invasion. The diagnosis is ‘national malignant greediosis.’ The treatment/cure? What happens to a parasite when the host ultimately dies?

  9. Pelgrin Mukoa

    So sad…..no respect for humanity, no sanity, no reason, no pity, no guilt, no conscience, no fear of God or respect for the law, nothing left to protect the common man. God help us

  10. Ben

    Let them continue with their project but allow poor Ugandans to get back on the road and fend for themselves. People are being psychologically tortured in the guise of mitigating spread of COVID-19. We already know what to do to protect ourselves.
    Enough is enough. People are literally starving under this lockdown. The members of the COVID-19 taskforce are busy sharing among themselves what is meant to help the poor and in order to have ample time for sharing they continue recommending that the lockdown should be extended. Remember what goes around comes around.
    Just release us and we struggle to fend for ourselves as we have been doing.
    Lord have mercy on your poor people.

  11. Francis Nyanzi

    What is very disgusting and disturbing is that as the poor struggle to live while locked up in their homes, the previledged class including the president and his ministers, the well connected and the rich are not themselves in lockdown! They continue to move in their cars including making senseless travels to their village homes. The president himself cannot keep to his home to be a living example of the lockdown but prefers to make all kinds of movement tantamount to loitering, moving for example from his huge official residences in Nakasero everyday for meetings and all sorts of petty things 30 km away to go to his office. Yet he forces other people to stay home and do things scientifically; he cannot meet his ministers where he sleeps nor can he hold meetings scientifically. The rich, who actually have the financial muscle to stay home are continuing with there businesses unhindered yet the poor that cannot manage to sit home are the ones forced to stay home as they wallow in misery, poverty and diseases other than Covid-19! It is very unfortunate!

  12. Kamugisha

    It is sad that when the government does some good and no ugandans die ,the biggest thing you take away is the weakness in the government. The government has out performaned.
    It is easy to criticize when you are not in leadership but that is fine.
    As long as the Ugandans are safe for now it is better than dying from crona.
    I am a Ugandan and I don’t agree with the way you show the government.
    I used to think Oxfam was helping us poor people but now I see .the truth.
    Thank you for showing me the way you undermine people’s efforts when faced with a pandemic.
    That is a low blow even for oxfam.

  13. Mary Ann Etling

    Thank you for your insight and expertise. You highlight the complexities and stakeholders of these ongoing issues very well. As a medical student, we are constantly discussing the implications of public health interventions (or lack their of) in low-resource settings. There are so many things to consider to protect the most vulnerable.

  14. Felix Biteetsigirwe

    I have seen food distributed around Kabalagala, Nanganda, Katwe, and Salaama. I know of an expectant mother who called RDC and was picked from Kyegegwa village, I know of a man in Kitabo who gets his bipolar medication through Covid task force ambulances that come to pick patients from Kashongi. In Mizi village, people are following the instructions as explained by the president to stop the spread of Covid and monitoring their population. That is what I see. If this is also happening elsewhere in Uganda, that is something to appreciate the government for. There is no civil society to arm-twist the governmet to do it. So far, we are not having Mass graves like those seen in developed countries with more responsible governments that we live to admire and use as our yard-stick. Corruption is sadly another disease that is pandemic and like Covid-19 it is worst in more developed countries because it is given Innocent names. In addition, every politician has never developed beyond acquiring and retaining power by using every situation to his/her advantage. The carrot could be a bag of beans in Uganda or unemployment relief benefit in another country in the name of protecting you from Covid lockdown effects. Painting Uganda as the worst case scenario is therefore not being sincere.

  15. I thank Dr Olive kobusingye for this importante information, though lives have been saved , the government of m7 wastes public money, m7 runs the country as if he is running a personal Family or a Family property. We do agree that lives have been saved but uganda is not tackling the pandemia with respect to ugandan citizens , it is stealing people and when you raise your finger ; the UPDF AND LDU start beating severely.

  16. Mukalazi Kibuka

    Note the names of those who criticized Dr Kobusingye’s revelations.
    They are telling a big story if you are one who pays attention to details.
    The good thing is that the criticisers are minutely very very few . That alone is a source of hope. Ugandans are finally getting United and covid-19 may have come at the right time to work as a catalyst.

  17. Honestly, COVID19 a virus from china and considered as a pendemic by WHO is a business opportunity for many of our presidents in Africa. From a layman point of view, we don’t know whether we even have a single case in Uganda.
    We have wolves who don’t care who on top of suffering citizens are asking more money and food. Currently they gave extra €10,000 to each member of parliament and they are forcing a move to forcefully diduct UGX 10,000 from every government worker and from private workers. We are rocording much more deaths as a result of lockdown than from the virus itself. Then there comes on top of the the floods that hit kasese district that left more than 120,000 affected. Houses and billions of property all were swept off. What’s has the government done? Nothing! It’s a horrible situation in Uganda.

  18. I have personally witnessed these things and worse, but lack the skills to document it for the anyone else to visualise.
    It makes me remember the comment by Munini on your book The correct line.
    He said you were so meticulously methodical like the surgeon you are.
    I think your writing skills is unmatched. While I respect the people’s president’s brilliance, I think Dr Olive would outshine him when both are presented at an intellectual platform.
    I am gonna Google for more of your works to relish on fruits of your endowment, starting wz what I’ve seen linked as The Patient.
    And by the way, how does one access your The correct line?

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