Yesterday, I had the opportunity to sit in at a local government-funded health clinic called “Zanta” here in Ndejje. There, I saw a side of the refugee experience that was entirely new to me.
Doctor Geoffrey typically sets aside Thursdays for his mental health patients. However, during the rainy season, these patients often resist navigating the treacherous muddy road that leads to the clinic. For some of them, getting out of bed is in itself a difficult task. Due to these low attendance rates, Dr. Geoffrey also makes time to see patients with other medical problems.
Medications are available for free at Zanta, but they only have a limited variety in medication types (typically, they have whichever meds are cheapest), and supplies run out quickly. More often than not, patients walk out with a diagnosis and prescription in hand, but no certainty of when the medicine might be available at the clinic. In time-sensitive diagnoses, obviously, this can have absolutely devastating consequences.
Of the seven mental health patients Dr. Geoffrey saw yesterday, six suffer from frequent seizures. Epilepsy is extremely common in the region due to malnutrition and brain trauma (typically brought on by accidents). The majority of these mental health patients also suffer of severe depression and post-traumatic stress disorder. Patients are prescribed medications with many side effects—again, these are the cheapest meds around.
A twenty-seven-year-old man named Samuel came in with his mother. His record explains that he has suffered from hallucinations, extreme mood swings, severe depression, and seizures. His hands shake nonstop from his medications. I have never seen someone who physically looks so utterly depressed. He was hunched over, unable to make eye contact with anyone and spoke as few words as possible. The expression on his face alone was enough to make me have to hold back tears and resist hugging him on his way out. One of the volunteer medical students smiled and told me he looked so much better than he had last week: covered in dirt and saliva, having seized minutes before his appointment—he had run out of medication before supplies were replenished at the clinic. Due to the outrageously uneven patient-doctor ratio, very little counseling is provided to mental health patients. The way they see it, prescriptions without psychological counseling are better than nothing at all.
Among the seemingly never-ending line of patients waiting to see the doctor was a 22-year-old couple and their two little girls. Their one year old has been suffering of pneumonia for six months. She was wheezing between sobs, and her father explained that she was only able to sleep while being held upright. Her ears were covered in discharge, and both she and her four-year-old sister had fleabites all over their legs. The young mother had been suffering of terrible abdominal pain. As Congolese refugees, these parents had no money or jobs, but their neighbors put together all the money they had so that the mother could have an ultrasound at a nearby specialty clinic. There she was diagnosed with diffuse liver disease. The medicine she must take for the rest of her life is not available for free, and she has no way of paying for it. The family walked out of the clinic with only a prescription to help solve the pneumonia, and an expiration date on the mother’s life.
A sixteen-year-old girl sat the doctor’s desk with her head between her hands, unable to speak for she was writhing in pain. A week ago, she tested positive for HIV. When the doctor asked what was wrong, she lifted up her shirt to reveal an oozing rash covering her entire front and backside—she has shingles, and there is nothing she can do but wait it out.
This is Dr. Geoffrey’s day-to-day routine. He explained that aside from the limited variety of medications provided to Zanta and the issue of extreme poverty, the real root of the problem here is war. The enormous influx of refugees in the area is too much for the Ugandan government clinics to handle. They can hardly cater to the existing Ugandan community, much less to millions of refugees too. Beyond that, they are living in unhealthily close and unsanitary quarters with no access to safe water, and little protection from the elements.
“Mademoiselle, we are going to die here,” said Jean-Pierre, a Congolese refugee in his forties, as he laughed and shook his head. The future is grim for refugees in Uganda, regardless of their backgrounds. Jean-Pierre, once a university professor in the Democratic Republic of Congo, lives in a miniscule home with eleven family members and close friends—including three orphans under the age of five. The twenty-five-year-old man he fled the Congo with two years ago is unable to leave their home, as he is plagued by flashbacks and fear brought on by post-traumatic stress. Jean-Pierre tells me of the land they had in Congo, their chickens and goats. The landlord that owns their home here does not allow them to raise animals on the property. He wishes his family and university had not shown adversity to the Congolese president’s terrible regime, just so that they could have continued to live in peace. To them, Museveni (the Ugandan president who has been known to abduct child soldiers and persecute homosexuals) is a good president, for here, Ugandans can keep on living their lives.
It’s true: happiness, health, and success (though a relative term) are hard to come by for refugees in Uganda. Thursday is “debate day” here for the English classes at HOCW, and yesterday’s topic was the value of knowledge versus money. Some students argued that one cannot achieve knowledge without money, others that while money makes the world go round, it is hard to come by without having knowledge first. “Even with some money in his pocket, how does one start a business if he has no knowledge?” a student prodded.
While some refugees like Jean-Pierre do not see value in gaining an education in Uganda (the job market is hardly a market at all), others recognize that without knowing English or learning more about the country they are living in, they cannot even say they tried to achieve success. It’s about baby steps here: finding a way to build a garden, to raise a chicken, to learn a trade, to prevent illness, to expand the mind, to stop dwelling on the past—no matter how massive a scar it left you with. Because, the reality is that Jean-Pierre is right: most of them will die here.