by Annah Kukundakwe

One lesson we pick from the wake of the Covid-19 pandemic is that accurate information is essential in facilitating decision making and maintaining good health. Last week, the New Vision quoted Jane Naddunga saying contraceptives encourage youth to have multiple sexual partners and expose them to sexually transmitted infections, with specific reference to HIV/ Aids.

The World Health Organisation defines a contraceptive as a device or drug that serves to prevent pregnancy. Contraceptives, also commonly referred to as family planning methods can be both short term, long term or permanent. They can also be hormonal or non-hormonal. The organisation also summises that “promotion of use and access to preferred contraceptive methods for young people, women and men is essential in securing the well-being and autonomy of women and girls, while supporting the health and development of communities”.

Indeed evidence suggests that contraceptives do not lure youth into sexual activity nor expose them to HIV/Aids or any other sexually transmitted infections, cause cancer or stop future reproduction. On the contrary, contraceptives such as condoms provide dual protection against both sexually transmitted infections and unplanned pregnancy. 

National statistics reported in the national demographics and health survey 2016, indicate that by age 15, approximately 68 per cent of young women and 62 per cent of young men have had their first sexual intercourse. Among sexually active girls, nearly 64 per cent had never used contraceptives. Research conducted by the Center for Health, Human Rights and Development (CEHURD) on human rights implications of inadequate contraceptive access and use in Uganda, indicates that limited access to information, especially among youth, is one of the key barriers to utilisation of reproductive health services including contraceptives. This has, in part, led to a rise in teenage pregnancies, causing a  nearly 34 per cent dropout rate among school going girls and exposing them to pregnancy related complications such as fistula or even death. 

Access to and utilisation of contraceptives is critical in protecting and attaining the right to health for both men and women through improvement of their reproductive health rights. This also ensures the productivity of Uganda’s young population by delaying child bearing and building human capital geared towards achieving the much desired middle income status. 

The current containment measures, such as the closure of learning institutions, being implemented to curb the spread of the novel Coronavirus has limited young people’s access to reproductive health and rights information. Similarly the ban on public transportation has made it nearly impossible for them to access the necessary youth responsive services. Therefore the onus is on stakeholders, including parents to ensure that young people continue to attain correct, accurate and age appropriate information on their sexual and reproductive health and rights, and support them to safely access services as the need arises. 

The writer is a Programme Officer at Center for Health, Human Rights and Development (CEHURD)

While the world struggles to find innovative ways to treat Tuberculosis (TB), WHO estimates that more than 58 million lives were saved by global efforts to end TB between 2000 to 2018. However, in 2018 alone, 10 million fell ill, 1.5 million died and 0.5 million fell ill with Multi-Drug Resistant TB (MDR-TB)^[1].

These statistics tell that even the best efforts employed sometimes fall short. Not everyone living with TB can access treatment and with the rise of COVID-19 globally, people living with Tuberculosis (TB) are likely to be more vulnerable to COVID-19 and its effects. The true impact of COVID-19 is yet to be felt globally as more than 300,000 are already infected and it has claimed more than 16,700 lives, with its epicenter shifting from Wuhan, China to Europe.

Both TB and COVID-19 are highly infectious diseases. While TB is airborne, COVID-19 is transmittable through aerosols and it remains from several hours to days on various surfaces^[2]. Both TB, MDR-TB and COVID-19 have similar identifiable symptoms such as coughing however, while TB can be handled through treatment and medication, no known medication has been identified to successfully treat COVID-19.

TB and MDR-TB treatment and medication can be accessed through leveraging on the Trade Related Aspects of Intellectual Property Rights TR9IPS) flexibilities to facilitate access to medicines and engaging in strategies to deliver cheaper medicines for low- and middle-income countries such as Uganda. It is also important to ensure that the government strengthens the procurement and supply chains to enable the ultimate beneficiaries to have access to TB and MDR-TB medicines.

However, COVID-19 has created panic and fear that has grossly affected manufacture, supply, sale and distribution of essential commodities. This has greatly hit the population as the workforce is on lockdown and quarantine is highly encouraged. Given the nature of COVID-19, prevention strategies such as the use of hand sanitiser, face masks and regular washing of hands every 20 minutes are highly encouraged. However, this does not absolve the government from investing in the healthcare sector.

COVID-19 now presents a great strain on public health compared to TB and it would require the government to establish specialized health care units to handle patients suffering from COVID-19. It would equally require recruitment of health workers, purchase of specialized equipment required to detect and treat COVID-19. Though Jack Ma’s contribution to Uganda is well received, it is grossly inadequate to handle a country that has a population of more than 40 million people.

It’s now time for the government to increase budgetary allocation and human resources for health to combat TB, MDR-TB and COVID-19. The doctors’ strike in November 2017 due to inadequate pay, exposed the vulnerabilities in Uganda’s healthcare sector however, all this can change if the government is committed to increasing its budgetary allocation to the health care sector for the benefit of all Ugandans. Health is not a privilege neither is it a luxury, it’s a human right worth respecting and worth investing in.

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^[1] WHO “Tuberculosis Key facts” 24^th March 2020. Available at <https://www.who.int/news-room/fact-sheets/detail/tuberculosis>

^[2] Science News “Study reveals how long COVID-19 remains infectious on cardboard, metal and plastic” March 20^th 2020. Available at <https://www.sciencedaily.com/releases/2020/03/200320192755.htm>

By Paul Wasswa – Lawyer at the Center for Health, Human Rights and Development (CEHURD)

Countrymen and Countrywomen,

Greetings to you all.

Today, I have come to address you on the issue of the Corona virus, abbreviated as Covid19.  They call it corona because, under the micro-scope, it looks like a crown (ekiruunga, engure).  This is a new virus but it belongs to the family of the common-cold (Senyinga, Rubyamira) group of viruses. It makes some people very sick because, being a new virus, all of us do not have immunity against it because we had never been exposed to it.

Fortunately, after listening carefully to our scientists and after watching commentators in the countries where it is already active, it seems to have two characteristics that will help us to survive it and defeat it.  Characteristic number one, is that it does not kill many of the people it infects.  Out of the approximately 150,000 people that have been infected world-wide, only about 5,000 have died, which works out at 3%.  With Ebola in Uganda, the percentage of the people dying was 67%.  Secondly, this virus enters the body only through the soft parts of the body: the nose, the eyes and the mouth. 

It cannot go through an intact skin like some of the diseases used to: yaws, leprosy, etc. 

This, therefore, means that even when you get near a person with the virus in his/her body, he/she can only infect you if he/she sneezes (Okwetsyamura) or coughs (Okukororra) near you so that the tiny and invisible bimira (mucous from the nose) or spittle (machwaante) enter your nostrils or those infected materials from the body land on a surface (a table, a chair, a door handle, a hand kerchief, etc.) where the virus can stay alive for 3 hours and you, then, touch it and, then, touch your soft parts of the body (the eyes, the mouth and the nose). It is this characteristic that makes it very infective.

The Cabinet, under my Chairmanship, on Monday, the 16^th of March, 2020, sat and decided as follows:

Although the kill ratio of the virus is not very high compared to, for instance, Ebola, this is if the victims are in perfect health. With the healthy young people, for instance, some information says that an infected person may not even know that he/she has any problem. 

She/he may defeat the virus without even knowing that it ever attacked him or her.  The real danger to society, however, is for old people, 70 years and above and people with other diseases they have been surviving with.  Such diseases are like: TB, HIV, diabetes, hypertension, etc. It is these that will be very sick or even die. Since we have a very large number of people living with HIV (1.4 million), having diabetes (800,00), hypertension (4.8m), TB (100,000 per year), we must do everything possible to ensure that this enemy does not come here, does  not find plenty of dry grass piled up and ready for flaming.  What is the dry grass that can help to start and sustain fire of a corona-virus epidemic? It is the big masses of people, gathered together and in close proximity.

What are these masses of people that are gathered in groups that can easily aid the spread of the virus? They are the following:

1.   The students. The NRM has promoted education.  As a consequence, today, there are 10.7million children in the Primary Schools; 2m children in the Pre-Primary Schools; 2 million students in the Secondary Schools; 314,548 students in the Universities and Tertiary Institutions.  This is a total of almost 15 million young Ugandans, distributed in 36,285 Primary Schools (Government and Private), 7,308 Pre-Primary Schools (Government and Private); 5,553 Secondary Schools (Government and Private) and 49 Universities and 1,543 Tertiary Institutions (Technical Schools, Teacher Training Colleges, Vocational Schools), etc., etc.  This is a total of 50,688 points with concentrations of 1,000 or more persons each.  When I visited Masaka SS in Masaka Town, it had 4,000 pupils without counting the other non-student people staying in that compound. It is wise that we temporarily remove these concentration points by closing all the Primary and Secondary schools as well as all the Universities and Tertiary Institutions for one month, starting with Friday, the 20^th of March, 2020, starting at mid-day.  All these institutions, without exception, should close so that we deny this virus those concentrations.  The 42 million Ugandans are divided into about 8million homesteads. Once the Educational Institutions population goes home, they will disperse into these 8million homesteads that have much less concentrations.  If the 15million were to disperse equally into the 8million homesteads, each homestead would take one and a half students. Since we cannot have a half a student, let us correct to the nearest whole number and we end up with 2 students per each homestead.  It is a smart way of avoiding these concentrations in the face of this danger. I have decided to close the Educational Institutions even before the occurrence of a single corona incident because I have observed the situation in other countries.  Once the epidemic breaks out, there is so much stampede that the first suspect to be affected is transport.  You have seen how Airports were clogged with people.  That crowding is perfect ground for new infections.  Let us, therefore, move early to avoid the stampede.

2.   Once we deal with the concentrations in the Educational Institutions, the next concentrations that we must deal with are the religious gatherings: prayers in Churches, in Mosques, open air prayers and services on Fridays, Saturdays and Sundays. In the interests of our people’s health, these should be suspended for a month with immediate effect.  Why with immediate effect?  The answer is, a question of logic:  “What if a person that is not yet infected today with the virus is infected tomorrow, Thursday the 19^th of March, 2020, was to be infected in the last Service that had been called “to pray for the last time?” How would God forgive us and how would we forgive ourselves?”  When it comes to health, it is better to be a coward and be on the side of caution.  If there is no danger after one month, that will be good. If there was danger, we would have avoided it. The Prayers will continue but in homes. The Religious leaders can use the TVs, Radios stations to continue preaching. His Holiness, Pope Francis, as usual set a good example of enlightenment on this by abandoning his customary preaching in St. Peters’ Square and is instead, using the TV.

3.   Then the next category of mass meetings are the political or cultural ─ Public rallies, conferences, elections, etc.  All these are hereby forbidden for 32 days with immediate effect.

4.   Up to today, the 18^th of March, 2020, Uganda, by the mercy of God, has been spared by not having even one case confirmed of the corona-virus. There has been many false alarms that our laboratories have proved false. However, there are countries in the world that have had many cases. We describe these countries as category one countries in terms of the epidemic.  These countries are: Italy, France, South Korea, China, USA, United Kingdom, Netherlands, Switzerland, Sweden, Belgium, Germany, Spain, Norway Austria, Malaysia, Pakistan and San Marino. We, with immediate effect, ban all out-bound movement by Ugandans to or through these countries, again, for 32 days.  Foreigners going to those countries are free to do so provided they do not intend to come back within the prohibited time.  We extend our sympathies to those countries and commend them for fighting on the behalf of the human race.

5.   We cannot stop Ugandans coming back from abroad, even from the category one countries that I read above.  However, such Ugandans will be put in a mandatory quarantine in a designated place but they will pay the cost for their institutional quarantine ─ food, etc.  If they want to avoid that inconvenience or cost, they can sit out the storm in the country of their temporary abode.

6.   The next points of mass concentrations are the non-agricultural work places: factories, hotels, large plantations, markets, taxi-parks, etc.  These should continue functioning but with SOPs (Standard Operating Procedures) put out by the Ministry of Health. These will include: compulsory hand-washing by all persons who enter or exit those work places, anybody with symptoms of sickness should not be allowed access for any reason, by the employers installing temperature monitors. The Ministry will publish the detailed SOPs as part of the Statutory Instrument to be signed by the Minister of Health with immediate effect.

7.   Then, the issue of Uganda-style weddings that bring together a pentagon of groups: the clan members of the bridegroom (Kishweera); the clan members of the bride (Kishwerwa, Omugore); the maternal clans of the two couples (Obukojja – Obwihwa); the school alumni of that couple; and the neighbours and friends. These tend to be big gatherings of people coming from the 6 points of the compass. This multi-directional source of the Mbagga attenders, can be as source of great danger. It is, therefore, decided that the wedding of this type should be postponed for 32 days from today. If, however, the couples intending to marry are really in a hurry, they could go for a purely scientific wedding, only involving the core stakeholders who are: the bride-groom, the bride, the best-man, the assistant to the bride (matron), the Priest (or the CAO), etc., as long as the number is less than 10 people.  The scientific marriage could, then, later, at an appropriate time, be followed by the Uganda-style one. Maama Janet and myself, used the scientific one in 1973 and we have not regretted.  The “Corona-virus” that time was the Amin regime. Much, much later, with adult children and grand-children, Janet and myself, were able to celebrate the 40^th anniversary of our marriage the Uganda-style with the whole Rwakitura compound full of people, with our grand-children as the brides-maids. The impatient intending couples could look at this model.

8.   The other occasion that gathers alot of people is a funeral.  Again, relatives, friends, associates, neighbours, etc., turn up in big numbers.  Again, with this virus, this is a danger point.  Many people could be infected there.  We cannot ban or post pone burials for 32 days. It would not be rational.  We, therefore, recommend that the burial is done by the relatives who are nearby.  They should be the ones to Kuziika (to bury).  Then the mourning (the kukungubaga – ekyosi) could be later when the rituals could be done. This may combine both science and culture.  Most importantly, it would be safe for the participants. If the deceased is, however, suspected of dying from the corona-virus, the State will take over and bury the person in the scientific way without the involvement of the family as we did for the Ebola victims. We should not replicate the lack of enlightenment that was exhibited in West Africa where the ritual of washing dead bodies was maintained even when people were dying from Ebola.  The consequence was that the “bathers of the dead bodies” ended up dying themselves in service of a non-scientific cultural practice. By confronting this disease with enlightened, scientifically based actions, we shall defeat it as we did with Ebola three times, with Marburg and with AIDS.

9.   The other big category of Ugandans are the farmers ─ the crop people, the cattle keepers and the fishermen. These account for 10million families according to the 2014 Census, with a population of 33 million people.  These, however, may not be a problem by themselves because they live in scattered homesteads and do not allow much concentration of persons.  If they are not pulled by the Churches and Mosques or by politicians for political rallies, they will go about their most useful activities in their dispersed form that is not a danger to themselves or to others.  However, they should all observe the hygienic practices recommended in this and subsequent communications. The Technical Committee on Health should, however, study more the issue of the fishermen. Although they fish separately, they live in concentrated landing sites. The Technical Committee will evolve the appropriate SOPs.  With the other category of farmers (cattle keepers and cultivators), the other danger area are the monthly markets. These should also be suspended for the 32 days. Buying of crops and livestock (cattle, goats, chicken, etc.), can go on but from the homesteads. They do not have to congregate.

10. The next frontline with this virus is public transport ─ the boda-bodas, the taxis, the buses, the mini-buses and the trains.  Everybody can see, the clear danger here, is of many people sitting next to one another in the confined space of the vehicle from Lira to Kampala etc.  Therefore, the advice here is: “Do not travel unless it is absolutely necessary, if you are using public transport”. Additionally, the companies that operate these means of transport should be given mandatory SOPs by the Ministry of Health: hand-washing, not allowing sick people on board, temperature monitors etc.  With these pre-cautions, public transport will continue.  However, in the event of an outbreak in a given locality, public transport in that area will be forbidden and the area will be isolated.

11. The next frontline of fighting the virus is to stop the merry-making ─ the discos, the dances, bars, sports, music shows, cinemas and concerts.  These are very dangerous gathering points with the virus around. Drunkards sit close to one another.  They speak with saliva coming out of their mouth. They are a danger to themselves.  All these are suspended for a month.

12. With these measures taken to deny the virus mass concentrations of Ugandans, the next area to look at is Hygiene.  The virus, according to the facts known so far, spreads by okwetsyamura (sneezing) and kukorora (coughing) whereby, through your micro-mucous (ebimira) or your spittle (otuchwante), you pollute the air around you and the virus can now enter the nose of the nearby people through breathing.  That is why it is important that anybody with a cough or cold should not go into public. You should self-isolate yourself or be isolated by force, if you are not responsible enough to govern yourself for the general good.  Even at home, always cough or sneeze into a handkerchief which you should frequently wash, dry and iron with a hot flat-iron or use a disposable tissue which you should then, either flush in the toilet or incinerate in a Sigiri. Do not spray the public or your family with your mucous or spittle through primitively sneezing or coughing without precautions or blocking your output in the manner suggested.  Once the individuals control coughing and sneezing, then the next danger point is touching surfaces with infected hands: tables, door-handles, telephone hand-sets etc. Here, the answer is to cough and sneeze into the tissue which you destroy so that your hands are not contaminated.  In any case, you regularly wash these hands. Therefore, your hands do not pollute the surfaces.  With money in markets and Banks, the Ministry of Health will publish SOPs governing that aspect, including disinfecting the coins, using mobile money, using online purchases etc.  Once you avoid open coughing and sneezing and you wash your hands regularly, then you will not contaminate the surfaces ─ the tables, the door handles etc.  That will protect the public. The virus, even if you have it, will remain with you until you get healed. It is good that for some time now, we have stopped the practice of shaking hands and hugging. There is also the side of everybody protecting oneself.  As you heard, the virus only enters the body through the soft parts of the body: the mouth, the nose and the eyes.  Even if the surfaces are contaminated with the virus and you touch those surfaces, yes the virus will be on your hand.  However, it will not enter your body unless you touch yourself in the soft parts of your body before washing.  These soft parts are: the eyes, the mouth and the nose. If you wash with soap, before you touch those soft parts, the virus will die.

13. Then, there is the issue of nutrition so as to eat foods that strengthen our body soldiers (the immune system) to fight the enemy.  Apart from ensuring a balanced diet which the District Medical Officers, through fortnightly addresses to all of you, should inform you about, in the particular fight against this virus, there is the need to take in good quantities of Vitamin C, through eating oranges and lemon and also eating ripe bananas to get folic acid and Vitamins B6. The folic acid and the Vitamins B6 help the nervous system of the body.  Ascorbic acid from the oranges helps your body to produce blood cells and build immunity.  Therefore, apart from de-congesting population concentrations so as to deny the virus big bodies of our citizens to easily infect and spread, the other important measure is the one who is having a cold not to spray the innocent with okwetsyamura (sneezing) or coughing into the open air.  Block your sneezing with the tissue, if you are the rich type that can afford tissues or into handkerchiefs that you frequently wash, dry and iron. Wash your hands with soap so that you remove the virus on your hands so that you do not contaminate the surfaces.  Then, on the defensive side, make it a habit never to casually touch your mouth, your nose or your eyes with unwashed hands, in case you touched contaminated surfaces. Eversince 1959, at Mbarara High School, when I attended my confirmation course (Kitebwaho emikono), the Reverend Yustus Ruhiindi advised us to use our left hand to receive the bread for the Holy Communion because the right hand would have been contaminated with the greeting of people.  It is now 61 years since. In all that time, my right hand is for greeting, opening doors, handling pens etc.  The left hand is reserved for myself ─ blowing my nose, etc.  This was long before these diseases ─Ebola, Corona-virus, etc.  It was a wise advice.  The Ugandans could look at it.  I never allow my right hand to touch my left hand before washing.  That is why I never clap hands.  I normally bang the tables with the same right hand that I donated to the public long ago. I never want my right hand to contaminate my left hand which is strictly for myself.

Otherwise, Uganda is prepared. We have isolation centres. We have long had the testing capacity within the country eversince the first Ebola days.  We have some factories providing hand sanitizers and we are going to have more.  Some factories will start producing face masks of the different types.  There is even some talk of treatment using the old choloroquine.

However, prevention is better than cure. On the side of the economy, there is no doubt that some sectors like tourism, hotels, sports, entertainment, etc., will be hit by the phenomenon of this disease.  However, others like the manufacturing sector will get a boost.  The countries of the World, by their selfish actions, are, again, waking up Africa that that it is ─ suicidal to depend on others.  I have warned our people to stop talking like the selfish foreigners by trying to stop the little we have, being exported to other African countries.  We can keep abit for ourselves but we shall share with the others whatever we have.  The blocking of imports should, therefore, get the long-sleeping Ugandans to wake up and use the huge amount of money they long earned by turning our market into a dumping point for foreign goods to build our own manufacturing capacity.  Through the BUBU, we shall help those groups.  Everything you have been importing, except for petroleum products for now, now make here. The US$7bn you have been using to import, keep it here.  Turn misfortune into an opportunity.

On Saturday 21^st March, the 41^st Anniversary of the defeat of Idi Amin’s forces at Rugando by the TPDF Force of 80 KJ and Task Force BN and Fronasa Forces, I have invited the top leaders of the Faiths for National Prayers at Entebbe State House. The few of us will pray for the whole country together. All of you pray in your homes, God will hear us.

In order to synchronize the dates with the closure of the schools on Friday, the actions of suspending the other activities that are starting immediately will run for 32 days not 30 days.

Source: The State House of Uganda.

After 7 years of Litigation, Mr. Mubangizi Michael and Musimenta Jennifer have received their full compensation for damages after they gave birth to twins but only got one! In this case we sought to challenge Baby theft at Mulago hospital.

“While this compensation will not bring back our child, it will go a long way in helping me provide a better life for my family. I am immensely grateful for CEHURD for relentlessly walking this journey with us.” – Mr. Mubangizi

At CEHURD we believe that this case should be a wake up call to Health facilities, Courts of law, the Civil society and the State to be mindful of Human rights’ violations that affect the most vulnerable in our communities.

CEHURD is going to continue engaging the beneficiaries to ensure that this compensation is of impact in their lives.

For Details about this case; see links below;

http://bit.ly/3cAZGSJ

On Wednesday 5th February 2020, Mr. Mulumba Moses the Executive Director of the Center for Health, Human Rights and Development (CEHURD) was an expert witness at the @HouseForeign Committee, Washington DC examining the far-reaching impact of the #GlobalGagRule on women, access to essential health services and on Civil Society Organizations.

Watch proceeding below; https://youtu.be/VWxEKtoOhPI

This hearing was under the theme “Unique Challenges Women Face in Global Health” and it was a huge opportunity to highlight the harms of the #GlobalGagRule and demonstrate the need for its repeal. The #GlobalGagRule demonstrates the consequences of repressive political decisions from other countries and how these can affect the health and well being of communities in countries like Uganda.

His testimony was published in the National Daily Monitor News paper on 13th February 2020 see link below;

https://www.monitor.co.ug/OpEd/Commentary/Global-gag-rule-cutting-off-funding-needed-health-services/689364-5454164-4g5tupz/index.html