Our story begins with two Johns Hopkins students, Daniel Minicucci and Isabella Yozzi, and one Makerere University student, Phionah Apiyo. All three of us share a mutual interest in Maternal Health, and were thrilled to learn we would have the opportunity to study the topic through the lense of multiple cultural perspectives. After meeting at the Ndere Center in Kampala, our group hypothesized we would discover a divide between traditional medicine and “Western” medicine among Ugandans, but were surprised to find that often times, herbal remedies and western techniques went hand-in-hand.
MATERNAL HEALTH IN RAKAI
We began our research by first spending 6 days with our respective home-stay families in the rural Rakai village near the Tanzanian border. Living with families in the village was a profound experience for American and Ugandan students alike- we were given the opportunity to participate in all typical families activities (including but not limited to: fetching water, preparing the popular Ugandan dish “Matooke”, collecting firewood, etc).
KALISIZO: MATERNITY WARD
Sanitation at the hospital was abysmal. In order to view the theatres, we were only required to slip into a new pair of shoes. There were no sterilization requirements, and common sights within the operating room included reusable gloves, dirty floors and surfaces, as well as poorly kept medical equipment. In order to get from the maternity ward to the theaters where surgery takes place, the patient would be forced to travel outdoors through crowds of people and over various long and dusty ramps.
Upon arriving in the family planning unit, we interviewed women who were seeking birth control in order to prevent another pregnancy after delivering unwanted children. Stigmas surrounding contraceptive use in Uganda remain rampant as preserving virginity remains a widely held cultural value. In addition to women seeking contraceptives, we interviewed women who sought family planning in order to improve chances of conception. One woman spoke about her preference in traveling to Masaka (a nearby larger city) in order to receive care with a gynecologist rather than the general doctors in Kalisizo.
We able to summarize our findings in a reflection session with our peers, and the topics of sex education in primary schools and marital and average birth age norms peaked their interest. Our discussion surrounding sex education compared the differences seen in Ugandan schools versus American schools: we found that most of us had a different experience learning about reproductive health. Ugandan schools emphasized abstinence only-education from a young age, and even in high school students were taught to follow the “ABC’s”- Abstinence, Be faithful, and use Condoms. In the U.S., sexual health curriculums varied from state to state, but course content typically included information surrounding preventing pregnancy, transmission of STD’s, and physiological information.
Reflecting on our time spent within the healthcare system in the United States versus in the Ugandan hospitals, we’ve concluded that quality of care is relative. As Americans, we were originally shocked to see the rural hospital, but for the significantly lower spend on healthcare per capita, Uganda manages to sustain mothers nationwide. There are obvious gaps in coverage, and with improved hygiene, additional resources, and accountability within the government, steps can be taken to improve the maternal mortality rate and overall maternal health outcomes.