Around the World The Hospital on Bushenyi Hill

On the top of a Buhweju District mountain, 35 kilometers from the nearest electricity, 45 kilometers from what used to be the nearest care, and several thousand feet over the moist and fertile local flat land, members of a two-year-old tea-leaf-based health care cooperative have actually built a tiny hospital and clinic. I visited the site just before I left HealthPartners. The local tea farmers had hand-carried both sand and water up the mountainside to build the hospital. They baked thousands of red bricks and then used those bricks to assemble a five-room building with a tin roof. That building now contains two maternity beds, five acute care beds, a tiny delivery room, one wire bassinet, and a table and chair in an exam room that also serves as a laboratory for doing malaria tests. The new care site has no electricity and no running water. The only lighting comes in through open windows. Flashlights are used after dark. The beds have clean, flat surfaces, but no mattresses or blankets. But, the site does have a physician and a nurse. And clean water. It takes care of people who really need care. It exists only because of the tea growers’ co-op. The Bushenyi Medical Center (BMC)—a private hospital and clinic 45 kilometers away—has contracted with the tea co-op to provide a doctor and nurse every day for that clinic. They agreed to provide that care on top of Bushenyi Hill because the co-op members who live on the steep hillsides surrounding the clinic have each agreed to set aside a portion of their tea harvest each month to pre-pay BMC for that care. Care arrived on that remote mountaintop only because the new coop gave people a way to pay for that care. A hospital with bare bunks for beds, no electricity, and hand-carried water may not seem like much to Americans. But, before that Bushenyi Hill Clinic existed, every person in the area who needed significant levels of care had to be carried down the mountain on wicker stretchers. Those stretchers doubled as local hearses—sometimes on the same trip. The road is steep, rock strewn and very slippery in the rain. Uganda has two rainy seasons each year. Carrying a stretcher down that steep mountain on a wet day is not a journey for the faint of heart, or for people who need care quickly. Now babies are delivered, minor surgery is performed, malaria is treated, and broken limbs are repaired on the mountaintop. Also, now that the Bushenyi Hill Co-Op Hospital and Clinic is in place, the people who are in the most dire straits have a new and more convenient access to the Bushenyi Hospital 45 kilometers away. The co-op has also created the area’s first real “ambulance” service. Taxicabs do the work. The health plan members who built the clinic building have collectively pooled part CLINICAL MEDICINE