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Rx for Survival — A Global Health Challenge

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Dispatches from the Field:

Amy Finnegan

True Health Warriors

By Amy Finnegan
Northern Uganda



September 2005

Amidst the heavy burdens of poverty, disease and war in Northern Uganda, a collection of dedicated healthcare workers have tirelessly put forth efforts to provide quality healthcare to thousands of individuals ill with some of the world's greatest global health challenges: HIV/AIDS, malaria, and tuberculosis. These nurses and physicians from St. Mary's Lacor Hospital, just outside the dusty northern town of Gulu, are some of the world's most creative, committed, and inspirational healthcare providers I have ever met: "health warriors" in the truest sense of the words.

A few weeks ago, I sat with Dr. Barbara Nattabi, a thirty-three year-old Ugandan physician from Kampala who came to Northern Uganda for her residency eight years ago and now directs the Antiretroviral (ARV) program for HIV-positive patients. I had returned to the North after a one-year absence to follow-up research I had started on the war — as well as to visit friends and colleagues I had worked with.

Seated on her brightly colored banana woven mat just outside her simple brick home that sits within the protective walls of the hospital, Dr. Barbara explained to me her motivation in upholding St. Mary's mission to treat "the poorest and the sickest." As we sat and chatted while the brilliant orange sun descended, flocks of children made their way inside the hospital gates for the evening. These "night commuters," as they have become known, leave their homes each night and walk several hours to evade the threat of attack and abduction by the Lord's Resistance Army (LRA), an insurgency that has been fighting the Government of Uganda for the past 19 years. Throughout Northern Uganda, there are 40,000 such night commuters who flee their homes nightly to sleep within the relative safety of bus parks, schools, and hospitals near towns. It is still ironic to me how, in a setting where the shadows of war lurk, a hospital can be transformed into a refuge for people to flee towards instead of away from.

As Dr. Barbara shared her vision for caring for the sick in Northern Uganda, a region with over 1.6 million people forcibly displaced into Internally Displaced Peoples' (IDP) camps, her engulfing passion for her patients, whom she feels unfairly bear the burden of disease, became clear to me. Living the first-hand challenges of managing a treatment program for 1,000 HIV patients in a conflict zone, she explained to me her credence that community mobilization is crucial to ensuring adherence to the drug therapies. While she can appreciate the global politics around HIV treatment therapy, in the end "I am an implementer," she said. Fundamentally, her commitment lies with her patients and to improving their quality of life. She does not take "no" for an answer from the various NGOs and funding agencies who are reluctant to put money towards community mobilization. I learned that community mobilization consists of community health workers regularly making home visits to offer counseling as well as providing support on various issues that may arise during treatment, such as opportunistic infections. Dr. Barbara feels vehemently that HIV-positive individuals living in IDP camps and other resource-poor communities in Northern Uganda deserve psychosocial support as they participate in the demanding drug therapy programs.

Facing nearly insurmountable constraints to providing quality healthcare such as a dire lack of security and access to medicines, Dr. Barbara and the other healthcare providers at St. Mary's understand that to address HIV and other epidemics in such difficult situations requires understanding the social, political, and economic context. It is also important to enable local communities' efforts to support patients on ARVs. In the ARV program that Dr. Barbara runs, St. Mary's has partnered with a local community-based organization called Comboni Samaritan, which ensures that community health workers visit patients in their homes to support them in taking the drugs. Dr. Barbara explained to me that starting on ARVs can be a scary experience, as one's body often has severe reactions to the harsh chemicals injected into the bloodstream. Beyond the difficulty of starting a new medicine, most of the patients on the ARV program at St. Mary's are also living in substandard living conditions with limited access to safe water, sanitation, and nutritious food.

Alongside extreme suffering on numerous levels, the team of healthcare workers at St. Mary's Lacor Hospital lives out an extraordinary commitment to providing healthcare to the poorest and the sickest. And beyond providing care, many of these physicians are also public health epidemiologists, having contributed to curbing deadly cholera and Ebola epidemics in the region. As a friend and individual who yearns for relief in Northern Uganda, I feel personally challenged by Dr. Barbara's commitment and passion. As I asked her what more I could do, she turned to me and thanked me for "thinking of this place" even when I am far away home in America. That night, I walked back to the guesthouse entirely humbled to know that such individuals live and work in forgotten places like Northern Uganda. Indeed, the undying willingness of Dr. Barbara and her "health warrior" colleagues to address social concerns that impact health and support community mobilization has made and continues to make a substantial contribution to global health.

About the author:

Amy Finnegan is a Program Officer for World Education, an international development NGO with a niche in informal education. She works on their Uganda programs, which focus on community mobilization and NGO capacity building in the field of HIV/AIDS. Committed to issues related to HIV and conflict, Amy has lived and worked in Uganda on a number of occasions.

Image of Dr. Barbara Nattabi

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