By Simon Wokorach
Adjumani
Adjumani District Health Officer (DHO) is highly skeptical on the alleged maternal death figures being reported by the Village Health Teams (VHT’s).
The supervisor of the VHT’s in Apaa Township Emmy Ocen said from the 110 sub-villages in the area, there is an increase in home deliveries from June to September 2023 accounting for 735 babies with 237 cases of miscarriages.
With lack of proper health care services, 35 of the mothers have died due to home deliveries since 2018 when Apaa health centre II was closed while 64 of the newborn babies have also died.
Ocen told GNNA that most of the mothers have died due to loss of blood and other birth related complications.
With a dire concern of the health care needs in the area, Ocen noted that, unlike in the past where the health facility was operational, the needy patients have to trek miles to seek medical care.
“We can’t help them any longer because even those essential drugs we would get aren’t coming. Right now we are only reporting deaths and other health complication…this is the only work we can do”
“Giving birth is between death and life and so one needs to be near health facility but with poor road networks in Apaa, some mothers just find themselves giving birth from home. A child should get first dose of vaccination on that very day of delivery but here we have children who go beyond one month without getting immunized with polio vaccine because we don’t have health facility” Ocen further explained.
Residents give account of their experience
A night before Catherine Apiyo delivered, the attackers had torched her grass-thatched house as she had taken refuge into the shrubs while in labour pain.
Apiyo, a resident of Apaa Township, recounts the tormenting moments she went through as she delivered a bouncing baby boy from the bush on that “joyful” day.
Apaa has remained contentious for over a decade. It was curved out of Amuru from Pabo sub-county by the Ministry of Land, Housing and Urban Development in around 2017.
The declaration that Apaa falls under Itirikwa sub-county in Adjumani district has created a situation where the area is a hot bed between the dominant Acholi and Madi tribes.
With hundreds of people allegedly killed between the two tribes, scores of huts burnt down, livestock and other property looted, Apiyo is one of the victims who has suffered as she brought life on earth one month ago.
While Uganda has outlawed traditional birth attendants from practice, Apiyo did not hastate to look for one.
“She saved my life and I had to pay her 15,000 shillings and a hen for the work she did. Many of us here would die if not because of these elderly mothers who attend to us” Apiyo aged 23 explained.
When GNNA visited Apaa, the young mother cuddling her baby seated in the Township had just fled their home located West of Apaa Township at Punu-Dyang.
With the ongoing land conflict between the Madi community from Adjumani District and Acholi from Amuru District, the government closed down the only health facility in the area five years ago.
The area without government health facilities is grappling with health care challenges with expectant mothers and children paying the price of the conflict.
Wilson Acuma, a local leader in Apaa Central noted with concern about closing of the government health facility in an area with close to 30,000 people leaving them in the hands of profit-making private clinics whose operations are not even supervised.
“We have over 10,000 houses which have been burnt by the people whose origin is not known to us. Right now about 200 new houses were burnt and people do not have what to eat. Some are sleeping in the cold where they are exposed to diseases” Acuma told GNNA.
Patients shoulder cost at private clinics
Amidst absence of the government owned health facility in the area, private health practitioners have positioned themselves in the service delivery gap with provision of services as patients shoulder the cost.
Robert Ndumabo, one of the practitioners, revealed that malaria remained the dominant health crisis in the area followed by ulcers, typhoid, though he declined to provide statistics of the patients.
Another practitioner Grace Alobo, a nurse whose business has survived in the area amidst conflict, equally noted with concern about the dire need for health care services in the area.
Her single room private clinic has seen mothers flocking in for antenatal care and the cost of services range from 25,000 shillings to about 80,000 for a single birth. Despite the cost, the proprietor was glad to tell GNNA in an exclusive interview that she has handled 30 deliveries in the last five years.
“The mothers are sleeping in the bushes because of the conflict in the area where they are getting malaria from. The mothers are delivering from home while others are from their hideouts from the bushes…some have developed fistula due to birth defect” She further explained.
The Amuru District Health Officer Dr. Alfred Okello said the district was directed by central government to stop going to Apaa in this financial year of 2023/2024 since it is not in their catchment area.
Adjumani DHO doubts Apaa VHT records
When contacted Dr. Henry Lulu, the Assistant Health Officer In-charge of Maternal Health in Adjumani District, he was skeptical about the highest number of home deliveries being reported in the area.
“We have a very good reporting system by our village health team but if because of the conflict in Apaa and the team there is reporting to facilities in Amuru then we need to harmonize that with Amuru local government but we haven’t received their reports here” Dr. Lulu told GNNA in a telephone interview.
He revealed that, with a total of 36,000 deliveries that Adjumani has registered in the last three financial years, the District Health Department has only registered 7 maternal deaths adding the team will verify the statistics of mothers in the Apaa where decisions shall be taken based on the facts on the grounds.
“I still want to dispute the figures provided, it’s erroneous and I won’t be sitting in this office if that is true for which we shall find out but our district has been the best in this region in the area of maternal health, this what I know and we have now heightened it more” Dr. Lulu further explained.
When GNNA contacted the Adjumani District Chairperson Ben Anyama to find out the district’s plan of re-opening Apaa health facility, he remained mute on phone and later hanged off.
Uganda registering positive shift
However, Uganda continues to register success in the reduction of both maternal and perinatal mortality according to the Ministry of Health which is aligned to commitment in the health governance and leadership with establishment of sustainable innovations and increased health sector investment.
The Uganda Demographic Health Survey 2022 report indicates that the maternal mortality ratio dropped considerably from 336 of 100,000 live births in 2016 to 189 of 100,000 live births.
Brief about Apaa
Covering a stretch of about 40sq kms and with a population of about 35,000 people, it is alleged that Apaa which has been under dispute for many years is situated in East Madi Wildlife Reserve was gazetted by Uganda government in 2002 after Adjumani passed a resolution to that effect.
A 2015 publication by Human Rights Focus an NGO based in Gulu City done bi-annually, this contested area was revoked as a hunting area by President Iddi Amin in 1972 paving way for people to settle in it.
Local leaders in Acholi sub region faulted Adjumani for passing a resolution that saw the parliament make a final decision that the area should be gazetted into a wildlife reserve at a time when people where still living in Internally Displaced People’s camps caused as a result of the civil war that lasted for over 20 years in Northern Uganda.
Resultantly, border demarcation between two districts was held in around 2017 using mark stones planted by the Ministry of Land Housing and Urban Development amidst heavy deployment as locals especially the dominant Acholi resented the exercise.
What would have been seen as a move to bring everlasting peace in the area has instead turned out to be a harbor of organized criminal attackers armed with machetes, bows and arrows occasionally attacking each other.
