The untold story behing Uganda's maternal deaths court case

'' Hurry up. I think my water just broke'' cries out 24 year old Kiconco Joan.

In this mud and wattle house, with a leaking banana-fibre roof top, the husband summons a handful of neighbours to carry his wife on a bicycle 'ambulance'.

Nyabikungu village is 21 kilometres from the nearest health centre with no running commercial transport  on its murram road except for motor cycle taxis which Kiconco Joan's husband's 8,000 shillings(abou 4 US dollars) can't afford.

'' I think I am going to die. I am going to die'' Kiconco Joan cries out as she is lifted to the makeshift wooden improvisation on a old rickety bicycle.

'' The mid-wife is not here. I need some money to  call  her to come here on my mobile phone'' a nursing attendant belts out after the Kiconco-carrying party makes the 21 miles to Rwakishakyizi health centre IV.

After a long one hour filled with unbearable cries from a mother in an agonizingly prolonged labour, the mid wife arrives and in haste lays down Kiconco for a quick manual examination. With the aid of the nursing assistant, they pull out a motionless baby who promptly switches to wailing after a little prick on the cheek.

'' There seems to be a retained twin in her. She has twins. I cant out the remaining baby. You have to go to Mbarara town.'' Kiconco Joan has not been attending ante natal care and has relied on a village 'traditional birth attendant for the past three months.

The Ugandan Tobacco industry frustrating government’s proposed Tobacco control law

Any avid follower of the Ugandan print media in the past few months will have noticed by now a sustained media campaign against the proposed Tobacco control bill 2011 perpetrated by the Ugandan tobacco industry.

The Uganda Tobacco Control Bill 2011 was initially presented before parliament in December 2011, moved under private members bill, by Dr Chris Baryomunsi. Deputy Speaker Jacob Oulanyah referred the bill back for re-drafting.

BAT Uganda has made unsolicited comments about the proposed Tobacco control bill through press reports in Daily Monitor ( 31^st May 2012 and 9^th July 2012) and the Independent (12^th July 2012) ,The New Vision (2^nd April 2012).  These articles bear the hallmarks of BAT since they carry the same carefully choreographed message, no matter who is being interviewed.

The press reports in question fail the balance test for any Journalist worth their name and the Ugandan public is being fed with a grossly imbalanced picture on the need for a Tobacco control law. 

These articles are quick to promote the BAT angle of how they are economically indispensable to Uganda through government tax revenue and tobacco farmers’ livelihoods which the proposed bill will purportedly curtail. What the articles fail to report is the following:

Tobacco use is the single most preventable cause of death in the world today. Tobacco use claims more lives globally than HIV/AIDS, Tuberculosis and malaria combined. According to the World Health Organization (WHO), unless urgent action is taken, tobacco could kill one billion people during this century. 

“Tobacco use is the only risk factor associated with all major non-communicable Diseases (NCDs) such as lung cancer, diabetes and  heart diseases. It is a risk factor for six out of eight leading causes of death, globally” said Dr Douglas Bettcher, Head of WHO’s Tobacco-Free Initiative. 

Although the Uganda tobacco industry is keen to highlight their economic importance to Uganda they are not telling Ugandans the whole story.

Despite their self-reported contribution of 60 billion in annual tax revenue, the Uganda Cancer Institute recently made a request of over 100 billion to treat cancers, including Tobacco-use associated cancers.

A World Bank study shows that for every dollar earned as tax revenue on tobacco products, three dollars are spent on treating tobacco-related illnesses.

Another study conducted at Mulago Hospital, 75% of patients with oral cancer had a history of smoking, with the number of years of smoking ranging from 2-33 years, according to a 2008 study report by Fredrick Musoke of Makerere University.

In a research we are conducting, preliminary results show that a significant percentage of patients attending the Uganda Heart Institute at Mulago Hospital have a history of Tobacco use. And that story on tax revenue on tobacco products?

‘’It is not the tobacco companies which pay tobacco taxes, it is the smokers’’ counters Dr Sheila Ndyanabangi, who argues that taxes on tobacco are simply passed on to consumers.

Tobacco growing farmers in the districts of Arua, Kanungu and Hoima are some of the poorest people in Uganda. President Museveni, while visiting Arua District recently, was astonished at the poverty levels among tobacco growing farmers there and publicly  commented so. MPs from Tobacco-growing districts are ironically some of the most passionate Tobacco control advocates pushing for alternative livelihoods for their constituents.

Uganda ratified the Framework convention on  Tobacco Control (FCTC) in June 2007, which is a set of internationally-agreed strategies for tobacco control that has force of international law. The FCTC calls for a ban on advertising of tobacco products, the display of graphic warnings on cigarette packs, an increase in tobacco taxes and alternatives to tobacco farming.

 

According to Rachel Kitonyo, a Kenyan working with the Africa Tobacco Control Consortium,  Uganda is out of step with other East African countries such Tanzania and (Kenya which  passed a Tobacco control law in 2007).

The drafting process of the Tobacco Control Bill 2011 is now almost complete with Dr Chris Baryomunsi expected to table it before parliament in the coming weeks.

The Political Economy of the Tobacco industry in Uganda

We are told that the tobacco industry is a major contributor to government tax revenue in Uganda.

We are also told that  there are 600,000 tobacco farmers in Uganda  in the five major Tobacco growing districts which include Arua, Nebbi,Kanungu and Hoima.

We also know that BATU, which has an estimated 90% market share runs several 'corporate social responsibility' projects in Uganda.

And we also know that BAT in 2011 announced an increase in Cigarette sales of 29% as compared to 2010.

And we are told BATU shares on the Uganda Stock Exchange have one of the highest share prices in Uganda.

Make no mistake. BATU is a multi-billion shilling industry that will do all within its power to protect its turf. And they are doing that well. They have appointed renown Businessman James Mulwana as their Board Chairman and ( Senior Presidential Advisor,John Nagenda before him).

The main stream press in Uganda has been infiltrated as we seen in our dailies' reporting. You see BAT is a major advertiser in the Ugandan print media.

And Politicians? Oh, those love campaign contributions and lobby gifts.

Why multiple sexual partners are driving up new HIV infections and a national emergency in Uganda

Ugandans are still reeling from last week’s bombshell of a revelation by Health Minister Dr Christine Ondoa that HIV/AIDS prevalence in Uganda has risen from 6.4% in 2005 to the current 7.3% in Uganda primarily driven by an increase in multiple sexual partnerships.

The findings are from a 2011 Uganda AIDS indicators survey conducted between February and September 2011 which interviewed an astonishing 11,340 households.

Concurrent sexual partnerships or a situation where an individual is having more than one sexual partner at the same time is the leading driver of new HIV infections in Uganda- according to the Uganda AIDS Commission.

 ‘'Have you ever seen a man who does not cheat? Tell me if yours doesn't cheat .All men cheat. But we make sure we do not have kids with those women we sleep with'’ celebrated Ugandan musician, Bebe Cool, was quoted in a Sunday Vision interview with journalist Carol Kasujja, in the May 6th 2012 edition, when asked to comment on rumours that his wife had left him over alleged infidelity.

The non-regular sexual partners are often called names: 'spare tire', 'side dish', 'away match', 'side mirror.’.etc.

The very choice of names betrays Ugandans' social acceptance of casual sex. It is only in Uganda that you will hear people refer to sexual intercourse as 'playing sex’. It is like a simple, casual game. Some kind of harmless fun. But it isn't fun.

Ironically, it is married couples or people in stable relationships who are driving up new HIV infections but also who are at a higher risk of HIV infection in Uganda because of reckless sexual behaviour. Married couples in Uganda have more unprotected sex than younger, single people. Married couples' aversion to condoms is legendary. ’'condoms don't belong in a marital bed' ‘one couple says defiantly.

A few weeks ago I listened in to a lively Saturday morning health talk show on Radio One where this was the topic of debate. Why are Ugandans partial to 'side dishes' to use the tongue-in-chick reference to extra marital sex?

And the panelists were not short of answers. '’Women lose sexual appetite as they grow older, yet mens' libido's don't wane with age so a man has to look out for it'’ a middle aged male caller volunteers.

‘’sometimes we women are in our periods and during such times; men should not be made to wait'’ a female caller volunteers. Ugandans are clearly socially accepting of marital infidelity. Although that is usually skewed in favour of the male gender.


In many Ugandan traditional societies, a man can be culturally granted divorce on account of a wife's infidelity although the reverse is not as easily accepted.

Cheating used to be a preserve for men. But not anymore. 'We now also have the money. When I know my man has a 'side dish', I also revenge and get a young man to satisfy my needs. These days we don't depend on men for money. We have our own money'’ says Namukasa Jane, 43(Not real name).

Statistics from Uganda AIDS Commission shows that males still cheat more than females although the latter are catching up fast.

Last year ,Dr Raymond Byarugaba,Head of the AIDS Information Centre (AIC)announced that new annual HIV  infection rates are set to reach 150,000 new cases compared to 120,000 the  year before up from 100,000 cases in years previous.

Uganda’s rising new HIV infections are out of step with declining global trends even in countries such as worse-hit countries such as South Africa and Botswana registering a 25% reduction in new HIV infection rates according to UNAIDS.

Ironically, Uganda was renowned for taming run away HIV infections in the 1990s making the recent spike in new HIV infections a  national emergency.

With donors scaling down funding for the HIV/AIDS treatment and new patients being turned away at AIDS treatment centres because of donor funding caps, increasing new HIV infections mean that  HIV treatment efforts are being hopelessly outpaced by new infections.

Michel Sidibe, the UNAIDS boss blames the rise in new HIV infections on ‘complacency’. It now seems that Uganda has to revert to the aggressive prevention programming favoured in the 1990s with Ugandans waking up to drums and hearing the messages of ‘love carefully’ .

Uganda at 50: A disillusioned ruling elite in Kampala?

In the early 80's, many joined the armed struggle against the Milton Obote regime, literally hours after sitting their last university exam at Makerere.

Many were in their 20's, eager to rid their country of  semi-illiterate Mal-administration of Idi Amin and Milton Obote and restore their country to the hope it was in the 60's. (a higher GDP than South Korea, Taiwan and Singapore).

They were charismatic, hopeful, confident, that they would restore Uganda back from its wrong turn. Many with a leftist brand of optimism.

They fought a protracted guerrilla struggle in the jungles of Luwero in central Uganda against a entrenched African state, initially with a handful of rifles. With more hope and conviction than might.

After a five-year struggle, they finally stormed the streets of Kampala, the Ugandan capital with a rag-tag army.

'' It is not a mere change of guards but a fundamental change'' they declared.

But  no body said turning guerrilla fighters into polished statesmen and sophisticated government bureaucrats  would be a walk in the park.

The state coffers were literally empty with a  virtually broken down state-structure.

What they lacked at the Central Bank they made up for governance chutzpah and political will.

The ministers drove Toyotas and lived a frugal life, from their most per-eminent leader to the half-dressed teenage kadogo  soldier, clutching an AK-47.

They  genuinely wanted  a fairer deal for the people of Uganda. And they believed.

But  a quarter of a century is a awfully long time.

With their dream of transforming Uganda a little more than a pipe dream, disillusionment set in.

'I give up on project Uganda. May be I can save myself and family instead'.

Ex-guerrilla fighters became capitalists over night. Of the crony kind of course. And many were transformed into consummate politicians per-occupied with winning the next election.

'Fundamental change'? It's more like regime survival. Political survival. Project Uganda? No, its project me myself and I.

The irony of Marxists turning into capitalists is not lost on Ugandans.

Uganda at 50: Have we graduated from dependence on foreign capital?

One of Uganda's biggest indigenous banks, Centenary Bank, opened one of the tallest structures in Uganda-the 11-storey Mapeera House in the very centre of Kampala's central business district.

International banks in Uganda own real estate and indeed, Barclays Bank and Standard Chartered own many of their own premises. So, what is the big deal with Mapeera house?

It was built with  US $40 million of the banks own funds with out external finance or even borrowing. Put another way, it was built with purely Ugandan money, teased out of the Ugandan economy.

Centenary Bank is a local bank with majority ownership by the Ugandan Catholic church and has been, for the most part, run by Ugandan management.  And that is debunking some myths: Ugandans can actually run a multi-million dollar  banking enterprise. With Teefe, Greenland and Uganda Cooperative Banks in the dust bin of history, we need to be reminded.

The Ugandan government announced recently it was going to borrow one trillion Uganda shillings from National Social Security Fund (NSSF) for infrastructure financing. Again, these are purely Ugandan monies, savings from salaried Ugandans to be exact.

At Watoto Church (formerly KPC) during one of the services, the pastor announced, what at the time seemed a hare-brained ambition, to raise a million US dollars from Ugandan church goers to help churches in Israel, Burundi and South Sudan. The irony was not lost on me especially with regard to the Israeli church.

This last sunday, the church announced that US $ 800,000 US dollars had been raised in shorter than a month-from Ugandan pockets. And the church is not done. They want to raise the balance of US $ 200,000 to make good on their million dollar milestone.

With the Ugandan government and businesses always looking out side our borders for financing, the trends above seem to suggest the domestic equity seems an option, it once wasn't.

Here is why  Ugandan local equity is such an issue.

According to  The Eastafrican, Tanzania currently holds a $ 1.2 billion loan for China's Exim Bank for the Mtwara- Dar es Salaam gas pipeline.

In 2011,Tanzania signed  off on a $ 320 million loan with Standard Bank of South Africa to pay international road contractors. And in this year's budget, the Tanzanian Finance Minister announced plans to borrow $ 822 million from international debt markets.


As Uganda marks 50 years of independence and with all the doom and gloom that analysts are dishing put on our jubilee, may be a shimmer of hope coming out of local capacity for financing million-dollar projects is some cause, however small, to toast to another fifty years.

Tobacco industry killing efforts to cut smoking deaths

Every year on May 31, the world stops and reflects on the millions who have lost their lives to tobacco use and the one billion others who are set to lose their lives to tobacco this century, if current trends are not reversed. Tobacco remains the largest preventable cause of death in the world. 

Every year it kills more people than AIDS, malaria and Tuberculosis (TB) combined. On average, smokers die 15 years earlier than non-smokers.

Tobacco use is set to become the leading cause of death in low and middle income countries by 2030. This vice causes 15 cancers, particularly lung cancer, and is the only common denominator in the non communicable diseases (NCD) epidemic which involves diabetes, heart and respiratory diseases.

This year, the World Health Organization (WHO) has selected tobacco industry interference in tobacco control efforts as the theme of the World No Tobacco Day.

The tobacco industry has been defined as ‘those persons and companies engaged in the growth, preparation for sale, shipment, advertisement, and distribution of tobacco and tobacco-related products’.

The leading tobacco companies in the world include Phillip Morris, British American Tobacco (BAT) and Japan Tobacco International. In Uganda, British American Tobacco Uganda (BATU) and Mastermind are the leading ones.

The tobacco industry is one of the most lucrative in the world. The Tobacco Atlas last year estimated that revenues from the global tobacco industry were likely to reach half a trillion US dollars, a year. Many tobacco companies are actually wealthier than many developing countries.

“The tobacco industry has historically employed a multitude of tactics to shape and influence tobacco control policy. It has used its economic power, lobbying and marketing machinery, and manipulation of the media to discredit scientific research and influence governments in order to propagate the sale and distribution of its deadly product. Furthermore, the tobacco industry continues to inject large philanthropic contributions into social programmes worldwide to create a positive public image under the guise of corporate social responsibility,” reads a WHO statement.

Because of the economic muscle tobacco companies wield, they hold sway over poor African governments and frustrate national efforts to cut tobacco deaths.

“The entry point for the tobacco industry in Uganda is the overly hyped economic importance of the industry in government tax revenue and tobacco farmers’ livelihoods,” says Dr Sheila Ndyanabangi, the Tobacco Control focal person in the ministry of Health.

But the disease burden and the costs of treating tobacco-related diseases far outweigh the reported economic importance and are not worth any life. The Centre for Tobacco Control in Africa (CTCA), a regional project funded by the Bill and Melinda Gates Foundation, is pioneering alternatives to tobacco farming through pilot projects in the tobacco-growing districts of Arua and Kanungu.

According to information from Uganda Tobacco or Health Forum, the tobacco industry reportedly put Uganda government under pressure not to increase excise duty on cigarettes in the 2008/2009 national budget, yet globally, taxes on tobacco products are said to be one of the most effective deterrents to tobacco use.

Tobacco companies all over the world are known to frustrate national anti-tobacco legislation through instituting stalling lawsuits and sustained media campaigns against proposed legislation.

John Amanya, Deputy Executive Secretary of the Uganda National Tobacco Control Association, observes that in Uganda we have already seen the tobacco industry sponsor press articles to try and punch holes in the proposed tobacco control bill which had its first reading before Parliament recently.

Despite the ban on tobacco advertising in Uganda, tobacco companies still stealthily advertise under the guise of corporate social responsibility sponsorships or indirect advertising, such as glossy job adverts in the print media.

Jackie Tumwine, a tobacco control advocate, recalls that despite the law banning tobacco advertising and promotion, BATU sponsored and chaired the Commonwealth Business Forum in 2007.

“The global tobacco industry kills six million people every year. It does this in a deliberate, systematic manner, complete with business plans, lobbying, political contributions and favours, and cash bonuses to its executives who kill the most people by successfully selling them their deadly cigarettes and other tobacco products,’’ says Dr Thomas Glynn of the American Cancer Society.