The burden of un-diagnosed disease.

In epidemiology, the tip of the iceberg phenomenon describes a situation in which a large percentage of disease is sub clinical, unreported or otherwise hidden from view. One way for me to better understand this has been through interactions with patients on the numerous community outreach sessions I have attended. In September 2016, I traveled with the Rotaract Club of Bukoto to their annual medical camp, #Kabutamback2016 in Gomba district, an area far deep in the central of Uganda. A resident confessed that they hadn’t been attended to by a medical doctor in over 30 years. He’d been presenting with a productive cough for two years; the sputum sometimes streaked with blood. His four year old had an equally disturbing persistence of a similar kind of cough for the same period of time. But while my mind raced and highly suspected tuberculosis, the rural setting is lacking in laboratory services to confirm my suspicions. I could only refer them to Gomba hospital, a draining 30km away.
The next girl who walked in was an 11 year old in primary three with a wide gait and limping stroll. Hers was one of the more touching cases. Clad in her school uniform, I initially thought she’d been corporeally beaten or worse. As her father eagerly provided though, it was far from that. She had a bad case of jiggers. Her nail beds were completely destroyed and in some parts of her feet, the jiggers were clearly visible. I later learnt from the father that the girl had not owned a single pair of shoes her entire life. He could only afford one pair—the one he wore.


Later in November, I was one of a team of 100 medics attending another medical camp in Kamwenge, Western Uganda, where some 7000 people from five districts had impressively camped at Ntara Health Centre two days prior to our arrival. On day one, our van could hardly make it through the throng as we tried to access the doctors’ tent and for the next three day I was increasingly wowed by the numbers that came willingly to receive medical care. Even then, the 500 people that were diagnosed with hernia right then couldn’t get the corrective surgery they required due to logistical issues. The medicines and health education we could afford to give couldn’t be enough for many cases and therein lies our real problems. The need for global surgery is one I’ll expound upon at a later time but it isn’t very hard to appreciate how lacking and how inaccessible our health system is
. The burden is definitely larger than what our health management information systems reports to the ministry of health. Health needs of the masses are evolving and so should the strategies.
I think that wide netted sector wide approach could be a good try in meeting a few of these health needs. With disease prevention and health promotion, casting the net wide isn’t that blind and ineffective an economist might argue. Most of the risk factors for presentation included laborious lifestyle, exposure to hazardous environmental conditions, poor diet and poor lifestyle choices (heavy smoking and drinking) among others. The net is certainly bound to grab something out of those.
I want hail all effort from Rotary international, Rotaract fraternity, community health organizations, corporate bodies et al who reach out to the most vulnerable people. You will discover on that for most this is the only medical attention these communities ever get! The spectrum of disease is bigger than in reports.

5 thoughts on “The burden of un-diagnosed disease.”

  1. I wouldn't agree more Prosper. This here is beautifully written. For the efforts, i shall thank the Rotaract Fraternity but more you..For somethings, it takes courage.

  2. I wish someone could do something about it but writing about it or even being in the Rotaract is one step forward! Kudos to you guys and keep doing more, keep impacting people's lives!!!

  3. Excellent article. I'm so glad you are doing these outreaches because it really opens your eyes to a fuller view of the health challenges in Uganda. Keep up the good work!

  4. Having been with you in both of the above mentioned scenarios I know first hand how true all this is... It's time for more people to come on board... Surely only together can we forge a better future.
    Well written bro

  5. Well written bro, I got to learn the same on a health camp in Mitooma district. Our Health system is a dead System

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