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Welcome.
Today we'll talk to Professor Susan Whyte
here at the University of Copenhagen,
which for many years conducted
ehnographic research in Uganda
with her husband Michael White
and colleagues from Uganda.
Maybe you could briefly
introduce us to the research you have done
for many years in Uganda.
>> Yes, thank you Flemming, it's a
pleasure to have the chance
to talk to you about a long story of
research in Uganda.
I started, together with my husband who's
also an anthropologist.
I started field work in eastern Uganda in
1969.
My particular focus, in that first field work,
was how
people interpret and manage misfortune.
Misfortune can be many things, but it
turned out that most
of the difficulties that people we're
confronting had to do with health.
>> In, in those early days.
What, what were the kinds of health
problems you, you would see people?
>> Yeah
>> Would consult the biomedical or
health services in general?
>> They were infectious diseases.
But when we first came, there, there was
really no national vaccination programs,
so immunization wasn't there.
I remember one of the very first days that
were living in this, this rural community.
we heard that a family in the neighborhood
had lost four
children, four children had died within a
space of a couple of days and
people were shaking their heads wondering
how it could happen.
And I, in retrospect, I, I suppose it was
measles.
There was lots of measles and there was no
measles immunization at that time.
So infectious diseases were, were very
common.
Lots and lots of malaria was there.
Children got to lung infections and
those
with those were the kinds of things that, that people
were struggling with.
We had one of the two cars in the whole
county.
So we learned about these things because

people
came day and night with emergencies asking
us
to please carry their sick person to the
local health center which was 14, 15
kilometers away.
So we got involved as anthropologists must
do by participating,
trying to help people who were struggling
with
problems of health.
So after we left in 1971 came a period
of political instability in Uganda, with
General Idi Amin.
And later with, other, dictators and, and,
periods
of political violence, disturbance.
So that
we weren't able to come back and do more
research in Uganda until the end of the
1980's.
When I started going back to do research
in the same part of Uganda it was after a
period of great instability
where the government health facilities had
been neglected, health workers weren't
getting.
Their salaries, or
they were very late, and they were totally
insufficient.
medicines were, were lacking.
So, there had been a real
breakdown, you could say.
And not a total disappearance, but a
real deterioration of the government
health facilities.
And
people had responded in a creative way.
because the health workers tried to access
medicines where
they could and they set up lots of small
drug
shops in the trading centers and near
the local
hospital and near the local health centers
that were there.
In the meantime, there had been
construction of
some new health units and among other
things,
22 rural hospitals had been built in that
period in Uganda.
So, the, the infrastructure, somehow the
buildings were there.
But it was functioning very poorly and
lots of times, the health workers
weren't at their posts because they were
doing other things, trying to make money.
And as one commented, they pretend to pay
us and we pretend to work.

So there were, there was a new kind

of healthcare that was becoming, that was
becoming evident.
I experienced when I went back in the
late 1980's, that local people often not
well educated
at all, maybe not having ever finished
primary
school knew more names of medicines that I
did.
So, so they, this was sort of a very
important development.
But when new
programs came in.
As they did when the donors
started to come back after this period of
political instability.
all the focus was on traditional birth
attendance or training community health
workers and, and the real community health
workers who were those who were selling.
The pharmaceuticals were, were ignored
because it was felt that they were, they
were doing something
illegal by selling medicines that were
supposed to be on prescription only.
>> In the late 80's how did the primary
healthcare approach in the primary
healthcare programs evolve in Uganda?
In 1986 after this long period of
instability a new government came into
power,
the National Resistance Movement with
President Yoweri
Museveni who's still the President of
Uganda.
And when he came in its, he turned over a
new page.
Primary health care programs definitely
came in and
there were things like community
distributors of anti-malarials.
training of traditional birth attendance
was popular.
and all kinds of the immunization programs
was, was developed and strengthened.
so things that really did make a
difference, but then
what happened also when the new government
came to power.
In 1986.
Was that the first cases of a mysterious
disease began to appear.
And AIDS was,
some of the very first international
scientific recognition of AIDS
actually came from studies in Uganda, in
the late 1980's.
What made Uganda unique.
At that time was that the new

president was extremely open about AIDS as

a national problem.
He had defeated his political enemies, and
then he
took on a biological enemy, which was this
new epidemic.
And so he, he was open, he said we must
confront
this, we must not hide it and he welcomed
donors to come
to support the fight against AIDS when
other African countries were denying it.
They didn't want to scare away tourists or
they
didn't want to become unpopular with their
own people by
admitting that there was a very huge
threat in
the country but Museveni must be praised
for his visionary
leadership in the beginning of the AIDS
epidemic but what it also meant was that
even more donors came in and began to Play
a, a crucial
role in biomedical healthcare in
Uganda.
to the extent in fact that by the
when was it, the 2008 I think.
The figures shows that
the Ugandan government was only covering
7%
of the cost of AIDS, fighting
AIDS and 93% came from donors, so that is
an
incredible dependence on external funding.
It was an interesting time.
when, when people were both yes, accepting
that AIDS was there.
And, and listening to and I think
taking, appropriating
really, the messages about how you could
avoid infection,
but at the same time using
herbal medicines and to some extent, also
turning to
new, enthusiastic forms of Christianity.
In, in trying to deal with those who were
already sick.
It wasn't until 2004, 2005 that
antiretroviral treatments
became available for free on a wide scale.
Before that, the illegals who had money
could buy the treatment.
From the late 1990's actually you could
buy treatment for,
for HIV in Uganda, but it was very few
people who could afford it.
It was way too expensive.
But then in one of the big programs
came on line in 2004 2005

many people come forward to test.

There was a
enthusiastic I would say, embrace of the
possibility of getting on treatment.
And, and a lot of support.
I think in many ways
because, Uganda had been so open about the
epidemic
from the beginning
that the transition to actually testing
and using treatment was also smoother
there
than it was in many other African
countries.
>> And, and has the increased focus on
treatments, has
that taken away some attention from
primary prevention in HIV AIDS?
>> Yeah, that's the big worry now
because what, one can see in Uganda was
that first of all, there was a very
dramatic decline in
prevalence and incidence.
but
now, from about something like some people
say 30% of adults
being HIV infected, it went down to,
something around 6%
which was a great success story at a time
when the world needed a success story,
because the AIDS epidemic was so
terrifying.
But what we've seen in the last.
3, 4, 5 years in Uganda is again
an increase in both prevalence and the
incidence.
You would expect an increase in prevalence
because people are not dying, they're
living with the virus.
So, the virus
has become a life sentence not a death
sentence as they say.
But also there's an increase in incidents,
that's
to say that more people are contracting
the virus and this is a very big worry,
for the ministry of health and, well, for
everybody.
>> And what are the most recent
developments we see in Uganda?
>>Yes, well as I was saying, I,
I think that the provision of treatment,
chronic treatment for HIV,
was a revolution in Uganda health care.
I think it's not fully appreciated
how important it was that people who used
to shop around.
You get your some medicine from your
health center then maybe you, it doesn't

help
so you'll go to a drug shop and you'll buy
another kind of medicine and
then maybe you'll try some herbal
medicine.
People shopped around.
But with the coming of, of these clinics
for
HIV, people had to join a program and they
became as,
as they call them in Uganda now, they
became clients, not patients but clients.
of a clinic.
And they were registered there.
They had their
file stayed there.
They had records there.
They were given appointments to come back.
And they, in a sense they belonged.
They got to know the health workers.
They'd.
They were, they learned a lot about their
condition, and it's treatment.
So they really, there was the, they
joined.
And I think it really increased
peoples confidence in biomedicine
generally.
that, first of all they were these
miraculous returns to help people
who were literally reduced to skin and
bones and rashes
in a few months had gain weight and
looked healthy
and fine and they got a second chance to
live and
biomedicine did that.
So some people are even saying that
all over Africa that successful AIDS
programs have increased expectations about
what bio medicine can do.
So, so that was, it was a very big step.
So what happens now?
The WHO has been calling for much greater
attention to
non-communicable diseases, which are
increasing in, all over the world,
but also in Africa, even though there are
still lots of infectious diseases.
But as people are living longer, they are
living with
chronic problems like cardiovascular
conditions, diabetes, cancer is becoming
more and more
recognised as, as a problem so an epilepsy
mental health
which a have long never with a never had
adequate what I
call chronic treatment programs of the
kind that are provided for HIV patients.

Now the question is will these other

diseases which are, some of which are
increasing.
will they be subjected to this
revolutionary move?
In healthcare
where you have chronic treatment for
chronic conditions.
It could be done but I think in Uganda at
least
the problem is that the health care system
is so
dependant on donors.
And the donors are so interested in AIDS.
that, whether an investment, an adequate
investment will be made in other
chronic conditions, is a big question.
It's something that policy makers,
and activits, and researchers like us,
should be concerned with.
>>Thank you so much.
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