Walking in a Ugandan Woman's Shoes; Lois Quam, Executive Director, Office of the Global Health Initiative

I've taken my own journey as a pregnant woman - twice - but on my recent trip to Uganda, I was able to walk in another woman's shoes. Ambassador Lanier, Senior Advisor Chris Dorval and I were taken on one pregnant woman's path through Uganda's health care system; from prenatal care to the crucial 24 hour period surrounding birth.

We set out to assess the Government of Uganda's progress in reducing maternal deaths, beginning our journey in the rural, western Kyenjojo and Kaborle districts visiting local health centers, which provide prenatal care and counseling and encourage women to get better health services as they near delivery. These sessions can be so critical to the health of mothers and their babies, yet most women only have one prenatal session early on in pregnancy. As we trekked our way up the mountains to Mitandi, a highly remote town, one of the main reasons for their lack of access to health services became apparent: transportation across these remote, rocky, rural areas is exceedingly difficult.

As Rosebell Kagumire, a Ugandan journalist and blogger who accompanied us on our journey, said, "Mitandi is one of the difficult places to reach in Uganda where health services and indicators are always way below the national average...The existing roads here are bumpy and when we headed there the rainy season had just started which will make most of them impassable." It's not hard to understand how even these local health centers can be a long distance from the villages in which women live, and without transportation, it could take them a whole day to make the trek.

From Mitandi, we moved onward to clinics where women give birth with the assistance of a skilled birthing attendant and finally, to district hospitals where women come from long distances if there are complications during birth, such as needing a C-section. A colorful account of our time in the field can be found at Rosebell's blog.

Overall I was impressed with the Ugandan people, their passion and drive to serve these women; however, I am deeply concerned about the overall level of government commitment and quality of care, which needs to improve drastically. It was also clear to me that one of the biggest challenges for women in labor is getting transportation from local clinics to facilities that handle complications occurring during child birth. We heard story after story of women being sent home to die simply because they could not afford to pay for transportation to the hospital.

If we are going to really save mother's lives, we have to address the transportation issue as well as provide other simple interventions that are often overlooked. I understand the difficult environment can make it challenging for women to get the health care they need, but there are effective and efficient ways to overcome these challenges. Chris Dorval provided practical examples of interventions to improve women's access to basic needs in an interview with Rosebell.

After finishing our site visits, the USG and the government of Uganda came together and signed the Uganda GHI strategy, an effort to apply a "whole of government" approach to USG health efforts to better serve the people of Uganda and to save the lives of mothers and children. This is a great first step and as we move from strategy to implementation, we must continue to think of new ways to tackle the tough issues, to work better with other partners, including the private sector and faith-based groups, and to improve the lives of women and children in Uganda.