It is what I was trained to do. Whatever the circumstances, I have to do everything possible to save lives," Baku says.
Nurses and midwives are usually the first point of contact with patients. It is no different for Mary Baku, a midwife at Riki Health Centre III in Arua District. About 25 kilometres away from Arua town, Baku's daily work is well cut-out to save the lives of mothers and babies. Her desire to fulfil the dictates of her calling, beams in a wide smile when she recounts the hundreds of mothers she has helped deliver in her career that spans over 10 years.
"There are mothers who come back and say thank you. This makes me happy," Baku says.
But like a horse which has four legs, yet it often falls, Baku's desire to save lives many times is tested to the point of frustration. Riki Health Centre, like many other small health facilities across the country, does not have electricity.
Ministry of Energy statistics show that only 21 of Ugandans have access to electricity. The ministry, however, plans to increase coverage to 26 per cent in the next three years.
At night, other than the flicker of a kerosene lamp that emits both necessary light and dangerous soot, there is no light to enable Baku see when helping mothers to deliver. At 135 deaths per 1,000 live births, Uganda ranks as one of the unsafe countries in the world to deliver from. An estimated 28 per cent of maternal deaths in the country occur among women and girls under 24 years. Some of the leading factors; include teenage pregnancies, not attending antenatal care, negligence of health workers and lack of essential commodities in health facilities.
"There is no infection control because in the darkness, things can become messy very quickly. We were really worried of infecting ourselves and infecting other patients," Baku says.
The World Health Organisation, lists norovirus, influenza, methicillin, tuberculosis, among others are diseases that spread highest in hospitals.
The facility delivers between 35 and 40 mothers each month. Services such as prevention of mother-to-child transmission of HIV, family planning and general diagnosis and treatment are also a given. There are two midwives at the facility and one in-charge.
A month ago, however, Riki Health Centre graduated from darkness to solar lighting donated by World Wide Fund, a conservation organisation with funding from the European Union under the Scaling-up Rural Electrification programme.
The lighting system comes as a relief to not only patients but health workers here, where roads to Arua town with better healthcare can be accessed are bumpy.
"When delivering a mother and she is pushing the baby, you need to talk to her. But how would you talk to the mother when you have a touch in your mouth? It was very difficult," Baku adds.
Lundia Asekuru, who said in an interview that she has suffered from asthma since 2003, was one of the first beneficiaries of a lit-up facility. "Sometimes I get an attack at night and they have to use a touch to take me to the centre. Even at the centre, I find them using a touch," Asekeru, a resident of Turupa village, Oluko Sub-county in Arua says.
"If this health centre was not around, I would be dead. It is easy to get treatment here since it is near. Government should provide electricity or provide solar systems to all health facilities, especially in rural areas," she adds.
Her request, State Minister of Health for General Duties, Sarah Opendi, said is something government is aware of and doing everything possible to extend power to all corners of Uganda. Opendi says with the abundance of the sun, which can be used to generate power, a bright future lies ahead.
The country also has the potential to generate 1,650MW from biomass, 800MW from peat, 200MW from mini hydropower sites and 2,000MW from large hydropower sites.
"It is still a challenge to have power in all health centres but overtime, we have connected a number of them to solar. It is efficient and we are working with the ministry of Energy to see that all centres have power," Opendi says. "Cabinet approved more money to rural electrification programme and these health centres will benefit," she adds.
In the meantime, however, minister Opendi cautions health workers to at all times wear protective gear before attending to patients.
"Because the ministry sends this protective gear to all centres, there should be no worries of infections even in darkness," she says. David Binega, the in-charge of Riki Health Centre, says without electricity, keeping medicine which requires low temperatures was a challenge. He adds that now, it is easy to keep vaccines and light the premises.
Binega adds that lighting is also providing security to the centre as patients and caregivers are able to see who is coming in and leaving unlike in the past when the facility was in darkness.
"As a result of the installation of solar energy, we are now able to respond to emergency cases in the night and administer vaccines to new born babies in time, which was not possible before," he adds.
Need for manpower
David Binega, the in-charge of Riki Health Centre, says there is need to recruit more staff to beef up the current manpower at the facility. The health sector is one that suffer from under-staffing. Although the World Health Organisation recommends doctor-patient ratios of 1:1000 and 1: 600 by 2020, the ministry of Health estimates that the ratio currently stands at 1:24,000.
The 2015/2016 annual Health Sector performance review shows that Uganda has a staffing shortage of anesthetic officers, which stands at 73 per cent, pharmacists at 60 per cent, nurses at 51 per cent and midwives at 25 per cent.
The 2016/2017 Annual Health Sector Performance Report also indicates the overall staffing gap of health workers in Uganda stands at 27 per cent.
Fortunately, government recently announced that they will recruit at least 15,000 O-Level leavers as community health extension workers to provide basic healthcare in villages in the next three years. The move is in line with the ministry's initiative to promote its new healthcare delivery model that focuses more on disease prevention to decongest public hospitals and health facilities in rural areas.