Kampala, Uganda — Finding affordable and accessible health care is a problem for the many women who work in Kampala's bustling markets. But so, too, is finding the time.
Hellen Alal has spent most of her 75 years selling fresh produce at Nakawa Market, arriving at the bustling hub on the eastern edge of Uganda's capital city alongside thousands of other vendors at 7 each morning and returning home around 10 p.m.
"I take care of grandchildren," Alal says. "My daughter died and left three, and then my son died and his wife left two children with me." Alal's grandchildren are ages 6 to 15; sometimes the eldest helps her at the market.
Alal has diabetes and gastric ulcers. During the interview, she complains of a lack of appetite and has eaten some akeyo, or African spider plant, a bitter-tasting herb used as a vegetable that Alal says helps improve her energy levels; she suspects she may have malaria.
But despite her ailments, she prepares the vegetables to take to the market where she has worked as a vendor for over 40 years; she has no time in her day to seek medical help.
Row upon row of stalls line the market, one of the biggest in the city, which is filled with bright red tomatoes, green vegetables, sweet potatoes and matooke, a type of banana. Smells of food being cooked are marred by the stench of open sewers that plague the space.
Food markets are indispensable in Kampala, serving as the main suppliers of fresh and dry foodstuffs to individuals and businesses alike. Nakawa is one of the largest markets, drawing approximately 20,000 shoppers on its peak days.
Women make up to 80% of the stall operators, but their long working hours often leave little room for addressing personal health concerns. This can lead to disastrous impacts on their health, says Dr. Michelle Barry, CEO of CTI-LifeHealth, a Uganda-based social enterprise. Those that run the market have raised concerns about the market's poor conditions posing health risks.
Seeking medical help can involve long wait times due to a lack of health workers. Uganda has just 19 health workers per 10,000 people, according to the government's 2021 annual performance report. Leaving their stall to seek medical help could mean a day or more of lost trading for market vendors, as well as the added costs of any treatment they may be prescribed.
Nakawa Market vendor Mary Lakwech has high blood pressure and diabetes. "I buy medicine from drug shops and use herbs; this keeps me from going to the hospital," Lakwech says. "I sleep in the market; home is far and most of the food arrives in the middle of the night," she adds, referring to the produce she buys to sell at her stall. Lakwech says she returns home every Saturday to "bathe properly," wash clothes and relax.
For many vendors, access to an efficient medical service isn't the only factor that threatens their long-term health.
Jamila Kikomeko, who has worked as a vendor at Nakawa Market for over 40 years, describes the market as a "filthy" environment and says vendors should prioritize their health, whatever the cost.
"There are only three toilets for the 10,000 vendors in the market," Kikomeko says. "Nobody cares. The leadership only care for themselves."
The number of vendors is closer to 15,000 at Nakawa Market, according to the Institute for Social Transformation, a Uganda-based organization that works closely with market vendors to address issues they face.
Joseph Mudhasi, market chairman, says most markets in Kampala are in bad condition. At Nakawa Market, one of the three toilets is under renovation, but there is no money to add more facilities. There are seven private clinics at the market that vendors can access where patients are charged for services. He says he can find space for anyone willing to provide health services to market vendors.
A lack of shelter over market stalls exposes vendors to adverse weather conditions for long periods of time, Mudhasi adds. This can weaken their immune systems and make them more susceptible to malaria from exposure to mosquitoes.
Kampala Capital City Authority is responsible for the market and agreed to an interview to discuss conditions at the market but did not honor the appointment.
Peter Kisakye, medical officer at Abby's Medical Center, one of the seven private clinics at Nakawa Market, says he sees about 10 to 15 patients per day, but most can't afford to pay for the service they receive and many owe him money. Kisakye says he offers patients payment plans so they can clear their debts.
Alal says she can't afford to get tested for malaria, let alone pay for any treatment that could follow. Meanwhile, fellow vendor Lakwech says she needs better bathroom facilities and a free health clinic on site.
Cecilia Namutosi, a 60-year-old market vendor and mother of six, has high blood pressure and diabetes. Two months ago, a wound she didn't get treated turned septic, affecting her mobility and leaving her bedridden.
"I wish I had gone to the hospital earlier," says Namutosi, who kept putting off seeking treatment because she was concerned about the cost.
Devas Kiwanuka, secretary of Kalerwe Market -- as big and bustling as Nakawa Market, just under four miles away -- says vendors at his market have no choice but to spend more time at the market than their homes. The vendors at Kalerwe Market are also mostly women.
"Most goods [that they purchase for resale] arrive late in the night or early morning, so some women have to sleep in the market with no [mosquito] nets and security, and this makes them susceptible to diseases like malaria -- some die because of malaria," Kiwanuka says. The work also prevents the vendors from spending time with their families, taking care of themselves and living a normal life, he says.
Most women buy over-the-counter medicines and only go to the hospital for emergencies, says Justine Namata, chairperson of Kalerwe Market Women's Savings and Credit Co-operatives.
Many of the women come to sell in the market when they are sick and they stay up until very late because they need the money, and this is not good for their health, Namata says. "Most women don't want to leave their stalls because they lose money -- they are the father and mother of their homes."
Sign up for free AllAfrica Newsletters
Get the latest in African news delivered straight to your inbox
Nathan Ruhiiga, senior business analyst at CTI-LifeHealth, says the organization has developed a "patient platform" where patients with a smartphone and internet can log in and access their profile -- an equivalent of a medical file in hospitals -- get prescriptions, test results and access their medical history.
But many of the women do not have a phone and internet connection; none of the market vendors interviewed were aware of the platform.
CTI-LifeHealth has also held free temporary medical camps and kiosks in Kalerwe Market where women can get tested and treated for diseases. A pilot project will expand these efforts to other markets around the country, says Moureen Wagubi, executive director at the Institute for Social Transformation.
Alal's health is improving. She diagnosed herself as having malaria and bought over-the-counter medicine to treat it. "My health is my priority," Alal says. "I want a health care service that can solve my problems fast. But this may only be a dream for me. Hopefully my grandchildren are able to realize this in their lifetime."
Beatrice Lamwaka is a Global Press Journal reporter based in Kampala, Uganda.
TRANSLATION NOTE
Beatrice Lamwaka, GPJ, translated some interviews from Luganda and Leb Acoli.
