Most of the roads in Kampala are dotted with potholes. Photo/STEPHEN OTAGE
For a country that considers potholes a national menace, Dr Ian Clarke’s autobiography How Deep Is This Pothole? is clearly a book on everything that is wrong with Uganda.
Having lived in the country for over two decades having first come here in 1987, Dr Clarke feels that the pothole menace is a symbol of the defeat of a whole society.
That collectively, Ugandans have allowed potholes to be part of their lives.
That fixing a pothole is not exactly rocket science, but Ugandans have failed or refused to deal with them at any level, he observes.
“…This national failure was possibly explained by the fact that potholes were tricky and unpredictable, and, like the Ugandan female population, they had a high fertility and multiplied at an alarming rate. If they were fixed, they then cleverly rearranged themselves in different positions, and drivers got confused as their location, so perhaps it was a strategic decision just to leave them alone,” he adds.
The author says in the book that, if one wanted a quick indicator of the level of development of any country the pothole index is an easy parameter.
On this pothole index, Sweden or Germany, would score 0 out of 10, since these countries do not even remember what a pothole looked like, while Uganda would score 10 out of 10, since it had redefined roads: a series of potholes with intervening tarmac.
How Deep Is This Pothole? is an autobiography of Dr Clark, an established GP who decides to leave his middle-class life in Northern Ireland and brings his family to Uganda to serve the less fortunate because he felt he would be more useful this way.
He tells of how he seeks to establish an alternative model for the development of healthcare in the country and how he survives cancer, twice, to see his grand children, in a continent where getting cancer is a death sentence.
He faces the trauma and the ghosts of his patients who have died of HIV or other diseases that afflict the country.
Although the Ugandan government provides free treatment, in practice the delivery of this healthcare is patchy, to say the least, and there is always a cost attached, Dr Clarke notes.
“Personally, I have always believed that it is right that patients should pay at least a small amount for medical services as this allows them to value the service…,” he adds.
His argument is based on the fact that most people in the rural areas are not completely destitute: they have some cash since they grow cash crops which are sold at the local market, but the little they have is not sufficient to cover all their medical costs.
For better health service delivery, Clarke contends that the private sector players should be willing to be held accountable.
Provided there is competition in the market place, even government departments would then begin to deliver a credible service.
“…I believe that long term sustainable development will come through the growth of a healthy private sector which will produce measurable results in a competitive marketplace.”
According to him, in providing healthcare the government rightly focuses on the essentials for the masses such as immunisations, the prevention of HIV, and treatment of malaria.
He adds that in terms of priorities to meet the healthcare needs of the population, Uganda seemed to have got things the wrong way round: it had the fewest doctors in the rural areas where majority of the people lived.
It does not facilitate the practice of specialist service such as interventional cardiology, or oncology; hence, those doctors who trained in such continued to work abroad.
Grant-funded HIV or research projects attracted the lion’s share of the cash, so many doctors were becoming project managers and researchers instead of clinicians.
“Therefore, there were few doctors in clinical practice, and many of those doctors stayed for relatively short periods. One would have to conclude that there was a disconnect between the various actors working in healthcare and the glaring needs which were not being met,” he says.
But he also criticises the poor work ethics and workmanship, nepotism, the bureaucracy hindering business, corruption, confused land policy hampering investment and the failure of enforcing laws and rules. It is a fair observation of the contemporary Ugandan society.
He does not spare the women who dump new born babies on the road sides, the poor nursing standards and attitude, and the bizarre ritual killings.
Neither does he spare the poor education system that stifles the ability of the students to think for themselves and be problem-solvers, which ill-equips them for the real world.
Dr Clarke further observes that today, in Uganda, image is everything and as men strive to have the right clothes or to drive the latest car, in the case of women it is not necessarily the Western stereotype of beauty which is appreciated.
The many African women who have a certain curvaceousness and fullness of figure, is seen as more attractive than the skinny Western lookalikes.
The akabina kanene (big bum) is still appreciated, and in the case of men, a big girth is perceived to be a sign of prosperity, Dr Clarke adds.
This contrasts with his earlier book........
“…The clothes someone wore or the car he drove was what impressed people and, unfortunately, these accepted values did not promote hard work, good character, or high moral attributes,” he writes.
