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UGANDA - LANDMARK CASE ON MATERNAL DEATHS

Source: Trustlaw // Jocelyn Edwards – 02 September 2011

Pregnant displaced Ugandan mothers at All Nations camp receive mosquito nets in Lira, northern Uganda November 7, 2005. REUTERS/Hudson Apunyo

By Jocelyn Edwards

KAMPALA, Uganda (TrustLaw)—During the 12 hours it took for Jennifer Anguko to bleed to death in a Ugandan hospital due to complications of childbirth, not one doctor or nurse attended to her.  Instead, her husband himself had to change her bloody sheets.

Anguko’s death, now the subject of a ground-breaking lawsuit against the government, is not an isolated incident.  Sixteen women die in childbirth each day in Uganda, or 6,000 every year, according to Uganda’s 2010 Millennium Development Goals report.

“From the time when she arrived at the hospital at 9 a.m. up to the time when she died, she was not even asked anything by one of the nurses or any medical personnel.  The nurses were just passing by,” said Anguko’s husband Valente Inziku.  His wife and unborn baby died last October in a hospital in Arua in Northern Uganda.

“She said, ‘Sisters, we are all women.  Can’t you come and help me?’  But they told me and the attendant to clean the blood.  We were the ones who were doing all that.  They never even touched her,” said Inziku.  The unborn baby would have been the couple’s fourth child.

The lawsuit, filed in March on behalf of Anguko’s family and the family of another woman, Sylvia Nalubowa, aims to hold the government responsible in their deaths.  The case is expected to be heard in early September.

The case is the first of its kind in Africa and viewed as a test of the responsibility of a government to provide its citizens with basic health care.  “We are saying (that not to provide this) is a violation of human rights.  That is why it is a landmark case in Uganda and Africa,” said David Kabanda, lead counsel on the case from the Centre for Health, Human and Development Rights in Kampala.

  “We want the court to declare that the death of women in childbirth in Uganda (for avoidable reasons) is a violation of our constitution,” said Kabanda.

For every 100,000 live births in Uganda there are 435 deaths, compared with about 24 in the U.S. and other developed countries, according to the United Nations Development Programme.

Many maternal deaths in the east African nation are avoidable, the result of lack of medical supplies, personnel or facilities, say activists.  A report on Anguko’s death by the hospital said there were not enough staff on duty on the day she died.  Only one midwife was present; three other women facing obstetrical emergencies also passed away the same day, according to the report.

Government hospitals in Uganda are ostensibly free, but are often understaffed and healthcare workers sometimes demand extra money from patients to pay for medical supplies or provide care, say activists.

 “I’ve traveled all over Uganda and we visit health facilities where the situation is so bad,” said Christine Tumuhairwe, the youth coordinator of the White Ribbon Alliance, an international coalition pushing for change to make pregnancy and childbirth safe for women and newborns around the world. “We see mothers that are lying in corridors and waiting to be attended to for one day, two days or three days.  They are about to give birth and we first have to tell a health worker, please there is someone dying here,” said Tumuhairwe.

“The many mothers who are dying every day are dying because [the government] is not doing what it is supposed to do,” she said.

The Ugandan government has argued that Anguko’s death should be addressed by the professional disciplinary bodies of the doctors and nurses involved.  “We think the deaths are actually (the result of) individual misbehaviour which cannot be blamed on the government,” said Patricia Mutesi, a lawyer from the attorney general’s office.

The state lawyer further argues that the government is constrained in its ability to provide healthcare by Uganda’s status as a less developed country and thus cannot be held responsible for its maternal mortality rate.

 “You cannot say that the government has violated the rights of people if the situation is caused by the economics of the country.  The fact of the matter is that this is a poor country,” said Mutesi.

In addition to the lawsuit over the deaths, activists have petitioned the constitutional court to compel the government to put more money towards health care in Uganda.  President Yoweri Museveni has come under criticism in Uganda for profligate spending in recent months.

 Jennifer Anguko’s husband, now the sole caretaker of the couple’s three children, places at least part of the blame for what happened to his wife and baby on the government.

“That is a regional referral hospital.  It is the government who employed the staff; it is the government who should monitor and supervise the roles of the staff there,” he said.  “The government is advocating that women go to deliver in the hospitals and health centres.  The facilities are there but when we go to the facilities there, the services are not provided.”