of friends, he secured help with escape plans. In the end, he left the country in a UNICEF vehicle that was destined for Kenya to pick up supplies. His wife followed soon after in the same manner.
Dr. Charles Olweny was already heading the Uganda Cancer Institute, now he took over as Head of Department of Medicine as well. Four and a half decades later, Olweny could still vividly remember how he became head of the Cancer Institute.
“In 1972 I was at the National Cancer Institute in the USA doing a Fellowship in Oncology. Six months to the end of the Fellowship a message came from Uganda. ‘You should return to Uganda immediately. If you delay your return there will be nothing to return to.’ Back home, Amin had expelled Asians, and many other expatriates had started to leave. All eight expatriate staff at the Uganda Cancer Institute were leaving. I wound up my stay prematurely and headed home. On arrival I reported to Kibukamusoke, who was Head of Medicine. He told me to go and talk to Prof. Kyalwazi. Kyalwazi was in Surgery, but had closer dealings with the Cancer Institute because of his research in liver cancer and Kaposi sarcoma. I went to see Kyalwazi, and told him that I could not head the Cancer Institute. ‘The Institute has just lost all its senior staff. I don’t think I can manage,’ I told him. Kyalwazi held my hand. ‘Son,’ he said, ‘you can do it. I will support you.’ Two expatriate colleagues were waiting to hand over the Institute. As soon as I showed up they effected the hand-over, wished me well, and left. To his word, every Wednesday without fail, Kyalwazi came to the Institute to do rounds with me, and to help me think through any issues I needed help with.”
Olweny lasted much longer than his predecessors in Medicine, but by 1983 when he left under the guise of a sabbatical, he was living like a fugitive, often having to spend nights in different locations to avoid ‘disappearing’ under the cover of darkness. These men were among the forerunners of the generation of Ugandan doctors that would go ahead to have illustrious medical careers while scattered in the diaspora. Despite the great odds, the Cancer Institute gave the world the first evidence that lymphomas (cancers of the lymphatic system) in all ages could be treated successfully with chemotherapy. Amidst scarcity, Olweny pioneered the concept of an essential drugs list, which concept was adopted by the World Health Organisation for use globally.
***
David Kisumba was the first Ugandan professor of orthopedics, attaining this status at a relatively young age. The reason few people know of him is that he died a truly untimely and premature death in a road traffic crash in Kololo, then a posh quiet neighborhood north of Kampala central business district. Nevertheless, he left an impression on his young nephew Mutyaba, who determined that he would be an orthopedic surgeon as well. The aspiration would have died the death of many such youthful dreams had his ambition not met with providence in the names of Professor Rodney Belcher, an American Navy flight surgeon who fell in love with Uganda. Belcher was no stranger to East Africa. He had started in Dar es Salaam as professor of surgery in the 1970s. In 1983, he came to Makerere as a Fulbright lecturer, but the country was in the throes of a full scale civil war, and he was forced to relocate to Nairobi. He was so committed to working in Uganda though, that as soon as the war ended in 1986 he started planning his return. Return he did, to a badly run down Mulago Hospital, where there were no orthopedic services to speak about, and where all surgical services were a major struggle.
Belcher realized that the care of the diseases of the bones and joints was always going to lag behind unless a department was created, where specialists could be trained. He was going to begin from the ground up. Mutyaba, who already had his general surgical training under his belt, was his first student. They needed a ward, an operating room, consulting rooms, classrooms … they needed a lot of infrastructure that did not exist in post-war Mulago in 1988. What did exist though, that came to their aid, was a dilapidated bungalow in Old Mulago that housed patients with disabilities, mainly from polio. Having identified the house as a potential base, Belcher had to find the money. For this he turned to his old friends from his Airforce days. One of them was now a Senator, and Belcher thought he might find a way to get his dream department funded. He went back home, asked around, and then decided that Mutyaba would be helpful in telling their story. Before long Mutyaba was on the plane to the US to work with Belcher on a proposal that would hopefully get funded through his Senate connections. Their hard work paid off. A War Victims Fund had just been established, and the Belcher-Mutyaba proposal talked of helping to treat the huge backlog of both veterans and civilians that had been injured during the five-year civil war in Uganda. With time, the money came, and the Department of Orthopedics was born.
***
Kweete had been on the antenatal ward for a week already. She had been admitted for observation, and to ensure that she would get specialist attention when she went into labour. So far, her pregnancy had not worsened her heart condition as had been feared. She did not know what to expect, this being her first pregnancy.
By 1986 Flavia Katende had been a tutor and midwife in Mulago for more than a decade. In that time, she had taught several generations of nurses and medical students to deliver babies safely. Yet every year there was some additional form of improvisation. She remembered that during her own training it would have been unacceptable for there to be only one health worker at a delivery. The doctor or midwife usually had a receiving nurse, so that once the baby was out, the receiving nurse took care of the baby while the midwife ensured that the placenta, or afterbirth, was delivered safely. They gave the mother ergometrine injection to reduce the bleeding, and gently rubbed the abdomen to encourage the uterus to contract, further reducing the bleeding from the placenta bed. The midwife or attending doctor did not leave the mother’s side until the bleeding had stopped, and the mother was clean and comfortable. Katende was aware that on some nights only one midwife was on duty in the maternity unit, assisted by inexperienced student nurses that were still terrified of the thought of cutting through skin and flesh. Delivery sets, the collection of instruments and supplies that one had to have in order to perform a safe delivery, had dwindled to a pair of rewashed gloves, old needle forceps, a blunt reusable needle, and loose cotton swabs. She had finally stopped giving her teaching on how to prepare for a normal delivery, because she could not bring herself to go through what were clearly fictitious lists. Students would never have seen the entire set anyway.
The evening of 25 January 1986 the maternity unit was unusually quiet. Lately the insecurity around Mulago had reached such levels that patients who did not come in before dark could not come in until the following morning. For some that would be too late. Katende would have gone home already but she was concerned about the teenager on the corner bed who was unlikely to have a normal delivery. She was the textbook high risk prime gravida, or first time pregnant: short frame, narrow pelvis, and baby’s head high above the pelvis despite the increasing contractions. Katende usually told young doctors to be aware of this ‘failure to progress’ in labor, and to plan intervention sooner rather than later, as a normal delivery was unlikely and unsafe. The doctors always took the decisions, but the more experienced midwives could tell which patients were not going to make it on their own. Katende knew the teenager was headed for a C-section, but there was no anesthetist in the theatre. There were no doctors either.
***
The war had been advancing from Luweero towards Kampala for a long time, and in many people’s minds this was how things were always going to be, but the last one month had been different. It was becoming clear that the guerrillas – ‘abayeekera’ – were going to enter the city, and that the government forces were not able to stop them. The day before the gunfire had been so close that the midwives joked that they did not need to deliver the babies – they were popping out at the sound of the shootings. But today was strangely quiet. The Senior House Officer and the interns should have been here. If they were not in the hospital by now, they were not coming. What was she to do with the young mother? Then there was the patient with heart disease as well. These two were going to need doctors.
***
Kweete went into labour in the night. The labour progressed without incident and at dawn she
