Florence Amito

Florence Amito is still preoccupied by a call she got the day before.

A warm, bustling nurse, Amito is in charge of the treatment clinic at Bardege Health Center III, a small government facility on the outskirts of Gulu. It’s the kind of place that’s popular with patients who live outside of the city of 145,000 people. It’s not as intimidating as the district hospital, and they can get more personalized attention.

Amito currently counts 540 clients on anti-retroviral treatment, many from far-flung villages that can take hours to reach. She knows because the clinic regularly took ARVs to those clients. They were able to do so thanks to seven community health workers. They were paid by a local non-governmental organization, The AIDS Support Organisation, to support the clinic. The NGO drew that funding from the U.S. government.

We have some patients who are far, far, far away and cannot reach the facilities, because of the bad roads. And then some are too elderly, they cannot come.

We would carry the clinic to the community. We would go and do all those services that the patient needs from the community.

The distances are very far. You cannot go there moving on foot. You need to go there in a vehicle. In some circumstances, when we go, the vehicle also cannot reach. Sometimes we park the vehicle two kilometers away from the homes, and then we just walk and go and give those services.

When the 24 January order was made, everything became difficult.

As part of the order, TASO’s work was suspended, including the community health workers it supported. It was a blow, but Amito thought they would be back after the U.S. government completed its 90-day review of foreign aid. Inexplicably, TASO’s contract did not survive that audit. That means the community health workers are not returning.

We have not been able to go the community. And I’m afraid to tell you that those patients are still missing treatment up to now.

She knows because they get in touch regularly to update her. The call yesterday has her particularly worried.

One told me that there are five who have gathered in one home. They have missed, meaning they don’t have any medication with them. They are trying to mobilize funds within themselves to try and maybe send one. But they have not yet realized the money. Because these motorcycles from there to here is 50,000 [Ugandan shillings]. It is five hours, because the roads are bad, especially now that the rains have come back.

For the want of about $14, all five of them are at risk of defaulting on their treatment. But Amito doesn’t know what to do. She doesn’t have the money. And then there are all the others who also need help.

Some of these mothers are in faraway places. They have not been able to come back and get their [ARV] refills simply because there is no transport, simply because they are lacking transport to come to the facility. Without treatment their viral load will go high. And without treatment there is a likelihood for them to transmit the viruses to their unborn babies or maybe breastfeeding babies. Because when they are not suppressing, well then definitely there is a lot of likelihood of transmission of HIV from one person to the other.

The virus is skyrocketing out there and it is a very worrying concern.

It is overwhelming for Amito to watch the collapse of years of effort to ensure even the most vulnerable, the most remote Ugandans would have access to HIV services.

People will die. People are going to die. That is a sad thing to note. People are going to die.