Robert doesn’t know his birth day.
Both his parents were killed in Uganda’s civil war and he has no other family. He was adopted as a young boy and did well in school.
Today he is one of only four kidney doctors in a country of 35 million people.
While communicable diseases such as malaria and HIV remain the most common cause of death here in Uganda, the prevalence of chronic diseases like hypertension and diabetes is on the rise. These conditions often lead to kidney disease and the need for dialysis. And in a place where kidney transplants are not an option, dialysis is a life sentence.
One of the many challenges in a resource-limited setting is that those in charge of health budgets have to make difficult decisions; ones that many of us in the west would find unpalatable. Faced with investing in high need areas such as public and maternal health, or those that have a relatively small number of cases like chronic kidney disease, the government here (and in most places like this) choose the former over the latter. Every time.
Through a sheer sense of will and some obvious negotiating talents, Robert has built the dialysis unit here from four stations to 28. He and his colleagues now provide dialysis for nearly 100 patients each week. Each of them generally come for two sessions per week and must pay $30 each time. The money goes directly to cover the cost of the supplies.
I asked Robert what happens if a patient can’t pay.
Still thinking about his response hours later, I am unable to reconcile it with anything I hold dear. At first I was shocked, and then I was angry, and now my emotions oscillate between resignation, sadness, and a weird sense of rationalization. For if it wasn’t for our support of Robert and his commitment and perseverance, even more people would die. I have told myself this a dozen times already today.
But I can’t shake the sad reality that where you live so often determines if you live.