Morphine yasooka kuleetebwa mu ggwanga lino emyaka 30 egiyise, kyokka ng’omugugu gwa kookolo gweyongera, enkumi n’enkumi z’abantu n’okutuusa kati tebalina bujjanjabi busookerwako oba eddagala eriweweeza ku bulumi.

Alex Mubiru agenda mpola okuva mu kisenge ekitaliiko bbugwe w’amabaati ky’agabana ne muganda we n’abaana ba muganda we babiri. Ng’anafuye mukenenya ne kookolo, ennaku ze azimala ng’agalamidde ku mufaliso omugonvu mu nzikiza, kyokka nnansi Roselight Katusabe aliwo okumulabirira ng’ayambibwako muganzi we Florence, ng’amuyamba okuyingira mu kasenge akatono akafunda mu maka ga nnyina ku kyalo Wakiso.

Okuva lwe yazuulibwa mu October ng’alina obulwadde bwa Kaposi’s sarcoma, ekika kya kookolo w’olususu ekitera okubeera mu bantu abalina akawuka ka siriimu, obulamu bwa Mubiru bweyongera mangu. Katusabe mweraliikirivu nti okussa kwe okukaluba kuyinza okutegeeza nti kookolo asasaanye mu mawuggwe, kyokka ab’omu maka gano basobola bulungi kugula mmere, ka tugambe pawundi 200 ezeetaagisa okukeberebwa okwandimusobozesezza okutandika okujjanjaba eddagala mu ttendekero lya Uganda Cancer Institute, erisangibwa kiromita nga 15 okuva mu kibuga ekikulu Kampala. Ebirime nnyina bye yasimba okulabirira amaka byabbibwa mu December. Mubiru, ow’emyaka 31, taata w’abaana basatu, agamba bugambo nti: “Njagala kudda ku mulimu.”

Awatali bujjanjabi, enteekateeka ya Mubiru mbi. Katusabe akola kyonna ekisoboka okukkakkanya obulumi bwe, n’amuwa eddagala lya morphine n’eddagala eritta obuwuka ku yinfekisoni, wamu n’akapapula akalimu akawunga k’emmwaanyi, ebinyeebwa, omuceere, ne ssukaali. Ng’oggyeeko obuyambi obukulu obw’endya, emmere eno emusobozesa okumira eddagala lye eriziyiza akawuka ka siriimu awatali buzibu bwa maanyi.

Embeera ya Mubiru y’emu ku misango Katusabe ne banne mu Hospice Africa Uganda (HAU) gye boolekagana nazo buli lunaku – era eraga okusoomoozebwa okunene okuli mu kibiina kino ekisookera ddala eky’okujjanjaba abalwadde abayi.

Abalwadde nga 70% ku 2,000 abewandiisa mu nteekateeka ya HAU balina kookolo, era abamu nabo balina akawuka ka siriimu. Batono abasobola okusasula okukeberebwa oba okujjanjaba embeera zaabwe era ne bwe baba basobola, si kya bulijjo abasawo okuzuula obubi oba okulemererwa okuwandiika eddagala erimala eriweweeza ku bulumi. Ebiseera ebisinga, omulwadde we yasindikibwa mu HAU, embeera ye tewona, ekintu ekinyiiza ennyo ttiimu, ng’ekigendererwa kyayo kwe kuwa obujjanjabi obukkakkanya obulumi okuva omuntu lw’azuulibwa ng’alina obulwadde obukomya obulamu bwe.

“Ekimu ku bisinga okutusomooza kwe kumenya ekitiibwa [ekyetoolodde obujjanjabi obw’okukkakkanya obulumi]. Abantu abamu balowooza nti kikwata ku kufa kwokka, naye kya muntu yenna alina obulwadde obutawona obutagenda kuggwaawo,” Antonia Kamate Tukundane, maneja wa pulogulaamu mu kifo kya HAU e Mbarara, mu bukiikaddyo bw’amaserengeta ga Uganda bw’annyonnyola. “Palliative care essira erisinga kulissa ku buyambi obujjuvu: Oli otya? Famire yo eri etya?Nsonga ki endala ezikwata ku bulwadde bwo?Tukuwa ekintu abasawo ne ba nurse kye batalina budde kukola.

"Oluusi omulwadde atuuka ng'alwadde nnyo n'afa, naye singa omulwadde twali tumumanyidde ddala, twandisobodde okunnyonnyola ebigenda mu maaso mu mubiri gwe, ne tukkaanya ku biruubirirwa ebituufu;ebyo byonna biyamba nnyo omulwadde. Abo abatusanga basiima nti baakikola."

HAU yatandikibwawo mu 1993 omusawo w’e Ireland Anne Merriman, n’okutuusa kati abeera mu Kampala, wadde ng’alina emyaka 87 avudde ku mirimu gy’ekibiina kino egya buli lunaku. Leero, HAU eddukanyizibwa ttiimu y’abakugu mu by’obulamu n’abakozi abaddukanya emirimu abasoba mu 70 mu bifo bisatu eby’omu bibuga: Kampala, Mbarara, ne Hoima mu maserengeta. Kifuuse ekyokulabirako eri obujjanjabi obw’okukkakkanya obulumi si mu Uganda yokka wabula ne mu Afrika yonna.

Mu 1993, HAU yafuuka ekibiina ekyasooka okuleeta eddagala lya morphine ery’amazzi mu kamwa mu Uganda oluvannyuma lw’okumatiza gavumenti nti akabi k’okunywa omuze katono nnyo. Dr. Merriman, eyali akoze eddagala eriweweeza ku mmere ng’akola mu Singapore, ye kennyini yagiteekateeka “ku sinki ng’alina ekibbo.” “Kyangu ng’okukola kaawa, ebirungo bina byokka: butto wa morphine, ekirungo ekikuuma, ekiziyiza pH n’amazzi. Era kya bbeeyi ntono nnyo,” bw’agamba.

Mu kiseera ekyo, amawanga asatu gokka mu Afrika ge gaali gakkiriza okufuna eddagala lino – Zimbabwe, Kenya, ne South Africa – bw’ogeraageranya n’amawanga 37 leero. HAU esobola okwewozaako ekitundu ku bbanja lino ng’eyita mu nteekateeka yaayo ey’ensi yonna, egaba okutendekebwa n’okuteekebwa mu bifo eri bannantameggwa b’okujjanjaba obulwadde bw’okukkakkanya obulumi okwetoloola ssemazinga.

Ebbula ly’eddagala lya morphine

Mu mwaka gwa 2004, gavumenti yayisa etteeka erifuula HAU y’ekola eddagala lya morphine ery’omu kamwa mu Uganda, nga ligabibwa amaduuka g’ebyobujjanjabi mu ggwanga era nga ba nnansi baagiwandiika ku bwereere. Emabegako, abasawo n’abasawo b’amannyo bokka be baali bakkirizibwa okugiwandiika, naye olw’okuba omusawo omu yekka ku buli bantu 50,000 mu kiseera ekyo, kyali kikulu nnyo ne ba nurse okutendekebwa okugikozesa.

Olwaleero eddagala lino litabulwa ekyuma ekyaweebwayo ekibiina kya American Cancer Society, kyokka ekifo ekitono ekiri mu kifo kya HAU’s Kampala kikyafulumya akatundu katono ku kyetaagisa. Okusinziira ku kibiina ekigatta abajjanjabi abakkakkanya obulumi ekya Palliative Care Association of Uganda (PCAU), buli mwaka ebitundu 11% bokka ku Bannayuganda ababalirirwamu 500,000 abeetaaga obujjanjabi obw’okukkakkanya obulumi – omuli n’okukkakkanya obulumi – be basobola okubufuna. Wadde kiri kityo, kino kirungi okusinga mu nsi nnyingi ezirina ssente entono, ng’obulumi obusobola okuziyizibwa buli waggulu nnyo.

Alipoota ya 2018 eyafulumiziddwa mu... Ekitabo ekiyitibwa Lancet ku by’obujjanjabi obw’okukkakkanya obulumi mu nsi yonna yayogera ku bbula ly’eddagala lya morphine nga “obutali bwenkanya obw’amaanyi obusinga okusiwuuka empisa mu by’obulamu mu nsi yonna.”

“Ku ttani 298.5 ez’eddagala lya opioid eriringa morphine erigabibwa mu nsi yonna buli mwaka, ttani 0.1 zokka ze zigenda mu nsi ezirina ssente entono, ate 50% ku bantu b’ensi yonna (abantu obuwumbi 3.6 ababeera mu nsi ezisinga obwavu) bafuna ebitundu ebitakka wansi wa 1% ku morphine egabibwa mu nsi yonna,” lipoota bwe yategeezezza.

Wadde kiri kityo, Uganda tennagenda mu maaso ku sipiidi abakugu gye baali basuubira. “Uganda eyimiridde,” Dr. Emmanuel Luyirika, akulira ekibiina ekigatta abajjanjabi abakendeeza ku bulwadde bwa African Palliative Care Association (APCA) bw’agamba. “Wadde gavumenti ekoze omulimu gwa kitalo nnyo ng’efuna eddagala lya morphine eriweebwa mu kamwa, mu nsonga z’ensimbi z’ebyobulamu okutwalira awamu, tekola bubi.”

Ensaasaanya y’ensimbi mu by’obulamu mu Uganda ekola ebitundu 2.3% byokka ku GDP, nga kino kiri wansi nnyo ku kiruubirirwa kya 15% ekyakkaanyizibwako gavumenti za Afrika mu 2001. Ekyavaamu ye nkola y’ebyobulamu etali nnungi okutuuka ku bujjanjabi obw’ensi yonna, ng’amalwaliro galina abakozi abatono ennyo, abaavu tebasobola kufuna bujjanjabi, n’abagagga bagenda ebweru w’eggwanga nga banoonya obujjanjabi.

Mu kitongole ekikola ku bulwadde bwa kkansa mu ddwaaliro e Mbarara, Sarah Nabushawo ye nnansi yekka asasulwa gavumenti ng’alondoola abalwadde. Agamba nti: “Kino kizibuwalira nnyo. “Abalwadde bakusuubira okukola emirimu emijjuvu, naye tulina omusawo omu yekka akola ku bulwadde bwa kkansa.”

Omutindo gw’obulamu

Ebweru w’eddwaliro ly’e Mbarara, abantu abawera 100 balinda buli lunaku ku ntebe ez’embaawo okwekebejjebwa. Abo abatuuka ekiseera ne balabibwa bakeberebwa omusawo omuto mu kisenge ekifunda nga tekusoboka kwekuuma. Abalwadde abalwadde ennyo n’abo abeetaaga okuweebwa eddagala oba okuteekebwamu omusaayi basigala mu waadi, gye kitera okubeera abalwadde okwebaka wansi. Mu waadi y’abaana, abaana abawera basatu bayinza okugabana ekitanda kimu.

Obutabeera na nsimbi za gavumenti tekitegeeza nti empeereza z’omu maaso zisukkiridde, wabula era nti gavumenti tesobola kunyweza bweyamo bwayo eri obujjanjabi obw’okukkakkanya obulumi. Ttiimu y’obujjanjabi obw’okukkakkanya obulumi eyatandikibwawo minisitule y’ebyobulamu mu 2022 okulabirira okuyingiza obujjanjabi obw’okukkakkanya obulumi mu nkola y’ebyobulamu terina mbalirira eyeetongodde.

Ba nurse n’abasawo abafuna ebisaanyizo okuva mu Institute of Hospice and Palliative Care in Africa (IHPCA), ekitongole ky’ebyenjigiriza ekya HAU, okukkakkana nga badda mu bifo byabwe eby’emabega olw’obutaba na mbalirira ya bakugu.

“Ebifo by’ebyobulamu ebitakka wansi wa 226 biwa obujjanjabi obw’engeri emu obw’okukkakkanya obulumi,” bw’atyo Mark Mwesiga, akulira ekitongole kya PCAU bw’agamba. “Naye bakikola ng’omulimu ogw’enjawulo, era twandyagadde gavumenti esiima, eyingize, esasule, n’okusigaza abantu ng’abajjanjaba abalwadde abakkakkanya obulumi.”

Dr. Muwanga Moses, omumyuka wa kaminsona avunaanyizibwa ku by’obujjanjabi mu minisitule y’ebyobulamu, akkirizza nti “eby’obugagga bitono,” kyokka n’alaga nti obutaba na bujjanjabi bukendeeza ku bulwadde mu malwaliro kisinga kulemererwa mu nsengeka okusinga ebyenfuna. “Buvunaanyizibwa bwa ddwaaliro okutondawo ensengeka entuufu okutondawo emirimu n’okuddukanya embalirira.”

Gavumenti nayo elwawo okussaawo amateeka. Enkola y’okulabirira abantu mu ngeri ey’okukkakkanya obulumi egendereddwamu okutondawo enkola y’omutindo gw’eggwanga, omuli n’ebifo ebisasulwa mu malwaliro, esigadde mu nkola ya bbago okumala emyaka etaano. “Okuva lwe twatandika emyaka etaano egiyise, omuntu avunaanyizibwa ku nsonga eno akyuse emirundi esatu,” Luyirika bw’agamba. “Uganda ebadde esika ebigere.”

Etteeka lino era lyandimanyisa abantu ku bujjanjabi obukkakkanya obulumi ku mitendera gyonna, okuva ku bantu abayinza abalwadde okutuuka ku bakulembeze b’omukitundu n’abakugu mu by’obulamu. “Abalwadde baffe abasinga beebuuzizza ku basawo ab’enjawulo mu bitundu ebiwerako,” Katusabe bw’annyonnyola. "Baggwaamu essuubi okunoonya eddagala – era mu kiseera ekimu, we basanga omuntu ng'akubirizibwa ssente; baddukira mu basawo b'ebimera oba abakulembeze b'eby'omwoyo abatayogera mazima. We batuukira, ssente zaabwe zonna bazimazeeko. Tebalina mmere era tebasobola kugula ddagala lya musingi."

Omugugu gw’endwadde ezitasiigibwa bwe gweyongera, n’obwetaavu bw’okujjanjaba endwadde ezikkakkanya obulumi bweyongera. Ekitongole kya Uganda Cancer Institute mu Kampala, ekifo kyokka mu ggwanga ekigaba obujjanjabi bwa radiotherapy, kiwandiika abantu abapya abawera 6,000 buli mwaka okusinziira ku consultant hematologist Dr. Henry Ddungu. “That’s just the tip of the iceberg. Abalwadde ba kookolo abatakka wansi wa 20% bajja mu ttendekero lino. Mu abo abakola, abasukka mu 80% bajja n’obulwadde obw’omutendera ogw’okusatu oba ogw’okuna – era bonna beetaaga obujjanjabi obw’amaanyi obw’okukkakkanya obulumi.”

Dr. Ddungu yandiyagadde okulaba ekitongole ekyetongodde eky’okujjanjaba abalwadde abakkakkanya obulumi mu ttendekero lya kookolo. Mu kiseera kino, abalwadde bakyagenda mu maaso n’okusindikibwa mu HAU. Wabula okukendeeza ku nsimbi okw’amaanyi kwongedde okunyigiriza eby’obugagga bya HAU ebyabadde bitono edda. Mu myaka kkumi egiyise, enyingiza yaayo ebadde esaliddwako ebitundu bibiri – okuva ku buwumbi bwa sillingi za Uganda 7.5 buli mwaka mu 2012 okutuuka ku buwumbi busatu mu 2022 – ekivuddeko abakozi okukendeera ennyo n’okukyalira awaka n’amalwaliro okutono. Emisomo gya buli wiiki ng’amaka omuli n’abaana baweebwa ekiwummulo okuva ku mirimu gy’okulabirira kati gibaawo omulundi gumu gwokka mu mwezi.

Ssente nnyingi emabegako zaava mu nteekateeka za mukenenya, ezaalekera awo okusonda ssente z’okujjanjaba abalwadde ba siriimu ng’abantu bangi abalina akawuka ka siriimu batandika okumira eddagala eriweweeza ku siriimu. Leero, obuyambi bw’ensi yonna butunuulidde nnyo emirimu egy’okuziyiza n’okupima. Obulabirizi obukkakkanya obulumi – nga bulina ebivaamu “ebigonvu” nga okwefuga okuddizibwa, ekitiibwa, n‟okuwummuzibwa okuva mu nnaku – kizibu okutunda eri abagaba obuyambi.

Okukendeeza ku nsimbi kitegeeza nti buli mukozi wa HAU alina okuba omuyiiya. Ku Mobile Hospice Mbarara, ba nnansi omukulu era omukwanaganya w’ebyobulamu Martha Rabwoni yeetegekera okukyalira Beinomugisha Ephraim, omusajja ow’emyaka 60 alina mukenenya ne kookolo ow’omutendera ogw’oku ntikko. Ku mulundi gwe yasembyeyo okukyala, yalina okulabirira okuzimba ekitanda oluvannyuma lwa munne okutegeeza nti abadde agalamidde wansi w’ettaka.

Okutuuka mu maka gano ag’ewala kyetaagisa okuvuga kiromita 15, ekisembayo ng’oyita mu luguudo olumyufu olujjudde enfuufu, n’oddako okutambula ng’oyita mu nnimiro y’ebijanjaalo. Naye Rabwoni musanyufu okusanga Efulayimu ng’atudde waggulu ku kitanda, ng’amwenya. Amuleetedde ebitambaala ebiyonjo, ssabbuuni, emmere ne morphine. Amugamba nti awulira bulungi: “Edda, nnali sisobola kwebaka misana wadde ekiro. Nnali nnyogoga nnyo. Nnagalamira awo nga mpulira obulumi bwe nnalina, naye kati ndowooza ku bintu ebirala.”

Wadde kiri kityo, Rabwoni mweraliikirivu nti amaka tegasobola kulabirira bulungi Efulayimu. Bawangaala butono ku musaala omutono muka mwana we gw’afuna ng’akola mu faamu eziriraanyewo. “Okulabirira okukkakkanya obulumi kukwata ku bintu ebirala bingi nnyo.Tukola bye tulowooza nti kyetaagisa,” bw’agamba, ng’akola ekiwandiiko okutegeeza olukiiko lw’ekitundu nti amaka tegalina kaabuyonjo wadde ffumbiro – ebyetaago ebisookerwako bye gavunaanyizibwako, ne mu bitundu ebisinga ewala.

Munne bw’akyalira Efulayimu oluvannyuma lw’ennaku ntono, aba akyali mu mbeera nnungi era abasanyusa n’emboozi. Naye enkeera ku makya, bafuna essimu nga babategeeza nti yafa ekiro.

Nga akomyewo e Kampala, Katusabe akeberedde Mubiru. “Olw’endya, alina amaanyi matono, era kati asobola okutambula okuva mu nnyumba okutuuka mu luggya,” bw’agamba. HAU ewadde ssente ezimu ku kukeberebwa kwe yeetaaga, naye si kwonna, era n’okutuusa kati tannatandika bujjanjabi bwa kookolo obukulu. Mu kiseera kino, Katusabe akyagenda mu maaso n’okumuwa obuyambi obw’omugaso n’obw’eby’omwoyo embalirira ye entono bw’ekkiriza.

Agamba nti: “Mu bujjanjabi obukkakkanya obulumi, tetuggwaamu maanyi.” “Bulijjo wabaawo kye tusobola okukola.”