A Visit to Uganda

Uganda is very much in the news at the moment because of the national elections and the unjustifiable controversy over Irish aid to Uganda, which in my opinion is well spent and accounted for.  Uganda is a very poor country, which has been ravaged by war in the not too distant past.  You can still see burnt out tanks at the side of the road.  Security is a big issue and expensive in Uganda.  My Hotel had three ring of security – the outer ring having armed guards. The second ring checked for guns which were not allowed in the Hotel.  The third or inner ring of security protected the bedrooms. Not surprising I did not see any of the “Irish glitterati” on holiday or buying holiday homes.  Uganda is on the equator, with wonderful sunshine and low humidity during my visit.


I also saw birthday parties for children in Uganda and weddings, which wouldn’t be out of place in Shrewsbury Road, Dublin 4. There is a privileged class as well. There is much greater in general family support in Uganda compared to Ireland.  Rejecting families of the kind that you see in Ireland are much less common in Uganda and when they occur, they occur within the more educated classes.


The people dress very neatly and well.  Because most of them are not overweight obviously then can carry clothes very well.  At weddings the attire is simply magnificent.  The average wage of people in the Hotel industry is 100 dollars per month. The hours are extremely long.


In Uganda particularly in the less educated classes polygamy is a status symbol and so a man having three, four or more wives is not uncommon. I wonder how Family Therapists or the Mater Hospital would handle this kind of family?


At the time I was there families were storing up on flour / grain for fear of social political implosion and there was a lot of anxiety and confusion about the upcoming presidential election.  The leader of the opposition had been jailed. It was December 2005 the beginning of the national elections.  I saw massive gatherings of political supporters with much noise.  There is considerable fear in Africa of the growth of the “Mugabe syndrome”.


As you walk around you see endless people walking appearing to walk forever and then other huge numbers of men sitting around under employed. The pace of life is about one fifth that of Ireland.  In the northern area where the Civil War is raging everybody has to go into the compounds at 3 p.m. in the evening for fear of attack or abduction.


Children are abducted and used as basically sex slaves for commanders of the rebel army.  When these come back or rescued they often describe that they have been the “wife” of a commander.  The higher up the commander that they have been the more status they have.  When they are abducted their first task maybe to kill their parents.  Caroline Moorehead pointed out that the Lord’s Resistance Army appeared to be defeated in 2002 but then abducted a further 8,400 children.  There are about 300,000 child soldiers in the world.


In one tribe the men sit around all day drinking a low alcohol brew and everybody drinks from this central container while the women go out to work the fields etc.  Children have their first taste of alcohol at baptism.  It is hardly surprising alcohol problems are a major feature.  Since the Afghan war drugs are being re-routed through Africa that formally went through Europe and this has led to increased drug problems in Africa.


The largest Hospital has a 9 year old CT scan which has scanned over 10,000 patients.  In this Hospital there is a ratio of 1 nurse to 20 patients during the day and 1 nurse to 50 patients at night.  The largest Hospital has a 1500 bed capacity and 80 to 100 deliveries per day of babies. I read in a newspaper that 53 is “a very advanced age”.


I attended psychiatric inpatient assessments and I saw HIV, syphilis, and many organic psychosis.  In the psychiatric setting it is not uncommon for HIV to present as an acute manic psychosis.


There was a great deal of police contact in relation to inpatients. I also saw traditional family problems.  An OPD session would have 50 patients for one psychiatrist.  There was 3 to 10 patients admitted per day in the Hospital. I worked with a psychiatric clinical officer which is basically a CPN who has permission to diagnose and treat psychiatric illness. She was superb in her diagnosis, assessment, and medical treatment.  Certainly we are going to see more of these performing throughout the world in the future.  Long waiting lists particularly in Child Psychiatry in Ireland could be solved if we had child psychiatric clinical officers who had extra training i.e. child psychiatric nurses with some extra training maybe in diagnosis and assessment so that they could assess people on the waiting list and referred more complex cases for multidisciplinary or child psychiatric assessment.  There was none of these endless wasteful multidisciplinary team meetings so common in Ireland.  The psychopathology was much more severe than we would see in Ireland.


The quality of the Registrars is similar to Ireland. I heard of one case while I was there where a traditional healer had fractured the skull of a patient.  This traditional healer as part of his treatment was to beat the patient.  The medications they use in the public service are Chlorpromazine, tricyclics, Haloperidol, diazepam, Chlordiazepoxide and lithium.  Psychologists have Cognitive Behavioural Therapy orientation.  In the Hospital the patients were uniformed in blue, green, etc..  The junior doctors wear white coats.


Every time a doctor or other health professional is taken from a developing country and retained in Ireland the government as part of its development aid should repay the full cost that the developing country had invested in training this health professional.  Ireland undermines health care in developing countries by taking vital health care professionals from them.


Christmas is a small event. I noticed no evidence in Entebbe Airport (famous for the Israeli raid on Entebbe) but I heard Silent Night being sung on the radio in Nairobi Airport three days before Christmas but that was about it.