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"If We Don't Do It Then Who?"

African Voices: Annamarie Kisalu, MBChB

Annamarie Kisalu, MBChB

MPH student, Uganda

Baltimore, Maryland

Photographed on April 7, 2006

As part of a team from Makerere University's Institute of Public Health, Annamarie Kisalu evaluated Uganda's implementation of the Integrated Management of Childhood Illnesses (IMCI) initiative for improving children's health. She visited health centers and hospitals in 10 districts in Uganda and learned about the problems with her country's health system.

“When you're training to be a physician, the things that have your adrenaline running are the complicated cases. When you go to the rural areas, the predominant problems are uncomplicated malaria, pneumonia, diarrhea... For the most part, these can be managed by a clinical officer or a nurse. It gets to the point where some physicians are saying, "I could do it in my sleep," or "My brain's dying out here."

But unfortunately when complications come, you're not able to deal with them because the health system isn't really functioning. I once prescribed IV quinine for a child with severe malaria at a hospital, but there wasn't any available. So out of compassion, I paid for the drugs. It was 5,000 shillings (about US$3) at the time for the whole course. This is not a luxury many health workers can afford because they don't always get paid on time. Besides, you can't buy drugs for all of the patients.

Seeing some of the problems, I finally understood why a fair number of my colleagues leave Uganda or go to work in nearby private clinics where they can have some satisfaction in seeing improvements in patients they treat.

We have to make our health system work. I would like to go back and practice public health, mostly towards improving the efficiency and use of our health system.”

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