Uganda

Pandemic Response Forsakes Patients With Chronic Illnesses

Uganda sees a rise in cardiovascular diseases after coronavirus-related restrictions limited access to treatment.

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Pandemic Response Forsakes Patients With Chronic Illnesses

Apophia Agiresaasi, GPJ Uganda

Julia Nampeewo sits at her home in Wandegeya, a Kampala suburb. Her symptoms for hypertension worsened during the pandemic when she couldn't access a doctor.

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KAMPALA, UGANDA — After she was diagnosed with hypertension, Julia Nampeewo had to visit a doctor at least once a month. Failure to do so meant the 56-year-old risked stroke, kidney failure, heart damage, blindness or even death.

But when the Ugandan government imposed lockdowns in response to the coronavirus pandemic, Nampeewo couldn’t access her doctor, whose hospital was a two-hour drive from her home in Wandegeya, a Kampala suburb.

The pork seller and mother of three started having constant headaches. “I knew my time to depart from this world had come,” she says. “I struggled to breathe.”

The local clinic didn’t have the drugs she needed, so doctors prescribed painkillers. Although they allayed her symptoms, she developed other complications later like nose bleeding. By the time the government eased the lockdown, she had to be admitted to the hospital for a week.

Nampeewo is one of untold Ugandans with chronic illnesses who suffered from government strategies put in place to contain the spread of the coronavirus.

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For about three months in 2020, the Ugandan government banned public transportation and allowed private transportation only for a few essential workers such as doctors and nurses. While the government employed these strategies to solve one problem, experts say they limited access to much-needed treatment for those with other chronic illnesses, which worsened their conditions and, in some cases, resulted in death.

This especially impacted patients with cardiovascular diseases, which affect the heart and blood vessels and are a leading cause of death worldwide.

Emmy Okello, head of the cardiology division at Uganda Heart Institute Mulago National Referral Hospital in Kampala, says more people with cardiovascular diseases are now seeking treatment after their conditions worsened during the government-imposed restrictions.

Before the pandemic, Okello says, the hospital treated about 200 patients daily. By the time the government eased the restrictions, this number had not only increased, but patients’ mortality due to advanced disease had gone up from 1% to about 10%.

Flavia Zalwango, programs director of research and advocacy at the Human Rights Awareness and Promotion Forum, a Kampala-based nonprofit, says the lockdowns made it difficult for those with onset and preexisting chronic illnesses to access hospitals.

Officials argue they’ve done what’s necessary to ensure the country’s health. Emmanuel Ainebyoona, senior public relations officer at the Ministry of Health, says the restrictions might have affected access to health care in the first few days of the lockdown, but officials recognized the importance of focusing on people with chronic diseases. These special cases, he says, could travel with permission from local authorities.

Even so, Zalwango says some patients with chronic illnesses couldn’t obtain permission because they didn’t have the required documentation such as identity cards and medical forms.

A 2020 government report on the impact of COVID-19 on the population acknowledges that the measures meant to reduce the spread of the coronavirus disrupted the delivery of health care services to other patients and led to the onset of more chronic illnesses. The report also notes an increase in demand for drugs to treat cardiovascular diseases such as hypertension that worsened during the pandemic.

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Uganda’s experience echoes what other researchers and scientists have observed worldwide. As the pandemic strained health care systems, governments shifted response efforts to the management of COVID-19. This has left patients with little access to health care, some because they worried about getting infected with COVID-19 at the hospital — leading to a rise in preventable deaths and disability — and others because of movement restrictions.

To mitigate the situation and meet the increased demand for treatment of cardiovascular diseases, Okello says the heart institute in Kampala is training more cardiologists. The institute has partnered with educational institutions such as Peking University in China to provide services in referral hospitals in Lira and Kabale districts, she says, and will expand to other regions once resources allow.

Nampeewo believes her situation could have been prevented had the government implemented outreach programs that eliminated the need for travel.

Ainebyoona says the Ministry of Health did deliver drugs to patients in their communities, but he acknowledges some challenges. “Not everyone was reached, especially homesteads in deep rural communities,” he says.

Nampeewo has left the hospital and now experiences only occasional chest pains, although the fatigue lingers. Others, like James Owobusobozi’s wife, weren’t so lucky.

The 55-year-old brick maker says his wife of 25 years developed what doctors diagnosed as ischemic heart disease, a condition that causes discomfort and chest pain if enough blood isn’t reaching the heart.

He says that she originally had diabetes but that her condition worsened due to added stress while she was taking care of her husband and two daughters, who had contracted COVID-19. “She was looking after us,” he says. “She was too stressed.”

Owobusobozi’s wife couldn’t access medical care due to the lockdown. And while all her family members recovered, she didn’t.

Apophia Agiresaasi is a Global Press Journal reporter based in Kampala, Uganda.