pGasping in hospital corridors, trailers that serve as makeshift morgues, emergency medical tents erected in New York’s Central Park: in March 2020, what we saw in Uganda looked like happening in high-income institutions in the US and elsewhere in the world. like scenes from a science fiction movie.
As physician researchers, well aware of the shortages of Covid-19 diagnostics, personal protective equipment and intensive care beds with medical oxygen in our country, we became increasingly concerned about the devastation this new virus could bring to Uganda and our medical practices.
With no Covid-19 cases reported on the scene, there was still time to make potentially life-saving preparations, from providing infection control training for hospital staff to educating the public on prevention and symptoms. Another positive was that, as a result of Ugandan universities’ longstanding global health partnerships, health experts from US and European academic medical centers and humanitarian organizations were already stationed in health facilities across the country.
With their extensive experience in treating patients with infectious diseases and researching infectious pathogens in low-income countries, along with their stated goals of serving the poor worldwide, these skilled workers were well positioned to support Uganda as it faced the world’s greatest public health challenge in decades.
Like soldiers on a battlefield facing an enemy threatening the population everywhere, we assumed that both combatants and commanders would not retreat or surrender in the face of danger. But despite years of consensus about the need to stand by people in materially depleted environments, the known consequences of Uganda’s health workforce shortages and the urgency of preparing for the pandemic, our international staff suddenly behaved as if the idea was that their staff would stay in Uganda. Uganda was absurd.
In the days following the initial chaotic reports from Italy, New York and elsewhere, we saw our non-Uganda colleagues receive a wave of evacuation orders from their respective home organizations and countries. By the end of that March 2020, we found ourselves essentially battling Covid-19 alone.
Ugandan policymakers did everything they could to keep the number of cases to a minimum – they had strong social distancing policies and contact tracing programs – but within months, the horror scenes we had previously seen on the news were playing out in Uganda’s underfunded and understaffed hospitals. From a safe distance, many partners from the Global North sent messages asking how they could help, a feeling that was appreciated but did not take away the void left by their abrupt disappearance.
From our experiences during Ebola epidemics, we fully understand the fear of working during a disease outbreak, including how challenging it can be to be separated from loved ones at such times. At the same time, the isolation with which we endured Covid-19 underscores a reality that Uganda – and other countries in Africa – have known for a long time: equality in global health partnerships almost always feels like a moving target.
While collaborations between scientists from high- and low-income institutions have delivered tremendous public health achievements, too often the priorities of partnerships are determined by the perspectives of those managing project funding, not necessarily by the individuals living in the communities. where these programs take place.
Sometimes, as was the case with staff withdrawals due to Covid-19, choices that affect both sides are made without the collaborating local scientists and clinicians even being asked for their opinion.
Medical and public health professionals in Uganda are well aware of the implications of this power imbalance, from the many studies conducted here without local authors to the wide pay differentials between ‘collaborating researchers’ of different nationalities working on the same programs. Local health professionals rarely openly point out these unjust practices, fearing that they or their beneficiary communities could lose access to much-needed funds and resources. Even when faced with a threat as existential as Covid-19, many Ugandan experts have not felt empowered to protest the ways in which they have felt abandoned and instead have remained silent while international partners trying to “fix” our public health systems via email.
We hope that as American and European organizations become more aware of these challenges, the response is not to withdraw even further from places like Uganda, but to take action so that vital global health programs can be implemented in a fairer manner. With the end of the pandemic in sight and the undeniable threat of future disease outbreaks, we especially hope that international staff will work to create more equitable contingency plans to continue operations in the face of public health threats. .
While evacuations may be warranted in targeted risk situations, such as cases of rebel insurgency or kidnappings of foreign workers, pathogens such as Covid-19 affect all susceptible hosts, regardless of nationality — visitor or local — and can spread to populations anywhere if not left. be addressed quickly. We call on global health professionals to more clearly identify opportunities to respond collaboratively to such situations and to be transparent about circumstances that would make in-person support for visiting staff impossible.
Physicians and public health experts from the North have remarkable expertise in responding to infectious diseases, but outbreak control teams in the South need to know if they can rely on them when they need it most.
There has been talk for decades about how to tackle the most challenging global health problems together as a global community. As health workers in Uganda struggle alone against Covid-19 for nearly two years, we wonder whether solidarity will indeed be the new norm, or whether the withdrawal will repeat itself again when a new pandemic strikes.
Stephen Asiimwe is an epidemiologist and program director of the Global Health Collaborative at Mbarara University of Science and Technology and principal investigator of the Kabwohe Clinical Research Center. Edith Nakku-Joloba is a senior lecturer in epidemiology at Makerere University School of Public Health, a sexually transmitted disease specialist and consultant to the Uganda Ministry of Health. Aggrey Semeere is a senior physician at the Infectious Diseases Institute at Makerere University and principal investigator for the East African International Databases to Evaluate AIDS.