The Health Centre Community.

Abstract

The greatest burden of malaria is borne by the children of rural sub-Saharan Africa. Each year nearly 90% of all malaria-related deaths occur in these remote areas, far from lifesaving medical care. In the Bugoye sub-county of rural Western Uganda, most families subsist on small plots of staple crops carved into the hillsides. Lacking transportation, worried parents carry their sick children down the narrow mountain paths to the health centre in search of care (Figure 1). The Level III Health Centre in Bugoye is the only facility in the sub-county—an area spanning more than 40 villages and nearly 60 km—equipped to treat cases of severe malaria. During the high season, hundreds of malaria-stricken children come to the health centre each week for diagnosis and treatment (Figure 2). Like many public health facilities in rural sub-Saharan Africa, the Bugoye Health Centre faces many challenges, including drug shortages, unreliable electrical power and inadequate staffing. The health centre is not shiny or new. There are no private rooms. The unfinished cement floors are cracked, the paint is peeling, the thin foam mattresses are worn and tattered and most of the equipment is decades old (Figure 3). What Bugoye does have, however, is a vibrant sense of community. In many ways, the health centre has the atmosphere of a bustling village unto itself. It is the heart of the sub-county. Entire families inhabit the wards, providing food, linen and clothing for their sick loved ones (Figures 4 and 5).The bright colours of children in church clothes dot the yard and groups of women gather behind the clinic, preparing meals over open fires (Figure 6). Village officials, health centre staff and local tradesmen sit on the benches at the front to wave to friends, chat about