Close But Too Far: The Health Tale of the Batwa in Uganda

Posted on January 19, 2016 Updated on January 20, 2016

By Cliff Abenaitwe

The 1995 Constitution of Uganda (Third schedule) recognizes 56 indigenous communities that existed in Uganda as at 1st February, 1926. One of these communities is the Batwa tribe- a unique group of indigenous people.

For generations, the Batwa lived in the forests of the Kigezi region (Kabale, Kanungu and Kisoro districts in Western Uganda), Eastern Congo and the forests of North Western Rwanda. Their way of life entirely depended of the forests.

These areas were not only for shelter but were sources of food, medicine as well as worshiping places. In the early 1990’s government gazetted areas where they lived as conservation areas paving way for the creation of EChuya Forest Reserve, Bwindi Impenetrable Forest National Park and Mugahinga National park. This was the turning point for the Batwa for good or for worse depending on the side you are looking at. One aspect to note about gazettment of these areas is that the Batwa were never compensated contrary to the statutory provisions on land acquisition by government.

The 2012 National housing and population census indicated that Uganda had 6,700 Batwa. The 2007 survey by the Organization for Batwa development in Uganda (OBDU) reveals that there are 3135 Batwa in South western Uganda with Kisoro district home to 1937 of them.

Today, that Batwa are mainly living in the districts of Kisoro, Kabale, Kanungu, Bundibigyo, Mbarara, Ntungamo, some in Lwengo and Mubende- in other words; they are scattered.

In all these areas, they are landless and this has negatively impacted on their political, social and economic aspects of life.

WAY OF LIFE

Majority of the Batwa are living as squatters. Their relationship with the land owners (the non Batwa) is that the Batwa stay on the land (where they build a small semi-permanent house and do some small scale subsistence farming) in exchange of cheap labor. This symbiotic looking but parasitic relationship has left the Batwa vulnerable, unsettled and poor.

During my visit to Batwa communities in Kanungu, Kisoro and Kabale districts, I found out that the moment the land lord is not satisfied with the output of the squatter, the relationship is terminated at will and the Mutwa’s family has to look for somewhere else to live. “I cannot for example grow long term crops like coffee or a banana plantation on the land that is not mine. The owner will not allow me or I might be chased before I enjoy the benefits of my sweat. Any time, you can be chased away. We cannot be sure of tomorrow”, a visibly worried Gad Bagaraya, a 32 year old father of six living in Ruceri village in Kisoro district told me. We just live today and when the land lord decides to terminate the relationship, you move to another area for another good Samaritan who will allow you to stay on his land, he elaborated adding that “ we are loved because of our energy and hard work character”.

Except the lucky few who have been resettled by some Non-Governmental Organizations (NGOs) that bought land for them, many others live like this but they hope for a brighter settled future.

Health Status of the Batwa

Health is an important aspect of every community. I took a keen interest in the health status of the Batwa Community in Kisoro district which has the biggest number of this unique group of people. Ruceri village in Nyarusinza Sub County is home to over 20 Batwa families each with an average of 5 members. It is about 25 kilometres away from Kisoro Town but because of the poor road (which stops somewhere before the village) and the distance you must walk up the mountain to the village, its takes over one hour to reach.

Residents here somehow managed to put up where they call home on what they say is government land. Some in this village built of land belonging to the non- Batwa residents. Being a mountain, it’s too rocky and cultivation is impossible. They work for the non-Batwa in the villages near-by to get food or small pieces of land to cultivate. As a result, their nutrition leaves a lot to be desired. “We eat once a day and our children have little to feed on”, Nyirandufiye Celina, a 38 year old mother of six told me during my visit to the area on a relatively warm Sunday morning.

According to health experts and the World Health Organization (WHO), breast feeding mothers ought to feed well to perform this task well. Just imagine what a baby would get from a mother who spends hours working but gets one insufficient meal a day!

In a community like this, housing will always be a challenge. Whereas a few through hard work and much austerity measures have managed to construct iron roofed houses, many stay in grass thatched or old tuplin thatched houses that leak when it rains. The temporary houses are small but a family will somehow find away to stay in. “I have worked and saved for years to get money to buy iron sheets for my house. It’s not easy. That is the reason why many people in our community stay in temporary shelter. They are also difficult to put up because grass and banana fibres for roofing are hard to get these days. They use the little they get and the houses leak when it rains”, Sserutokye Stephen,

the Ruceri village vice chairperson explained.

During the visit, I entered 7 houses (both the iron roofed and the temporary roofed) and I noticed that clothing is inadequate and so are beddings while ownership and use of mosquito nets is a distant dream for all.

Latrine Coverage

The national latrine coverage stands at an average of about 77 percent. This is not a good figure but there are many areas doing badly in latrine coverage including Kisoro district. The Kisoro district Chairperson Ben Mutabazi puts the latrine coverage at about 55 percent- way below the wanting national average. The latrine coverage among the Batwa is however worse. It is less than 30 percent in Ruceri village in Kisoro district and in other Batwa communities I visited in Kisoro, Kabale and Kanungu districts.

In the Ruceri Village (Batwa community), only three households have pit latrines. The chairman, the vice chairman and one resident are the only ones with pit latrines. However, they are shallow and temporarily built with no roof. Their quality notwithstanding, these homes are better than the rest where members defecate in bushes.

This is a great health risk to the people of this area. Records at Mutorere Hospital in Kisoro District reveal that diarrhea cases account for the highest number of disease cases among children.

The world health body denotes that many diseases are associated with poor sanitation.

“Inadequate sanitation is estimated to cause 280 000 diarrhea deaths annually and is a major factor in several neglected tropical diseases, including intestinal worms, schistosomiasis, and trachoma. Poor sanitation also contributes to malnutrition”, WHO elaborates.

It’s inexcusable for a family and a community to be without a latrine in the modern day age but the reasons advanced by this community deserve a hearing. According to Ruceri village Chairman John Haguma-Imana, land is the greatest problem. “The owner of the land gives you a little portion of land to build your home and establish a small garden- so you find yourself with no land for a latrine.

Besides, these people are temporary here. Am not trying to justify our problem but the people here are facing a number of challenges”, Haguma-imana explained.

An old adage goes – Health is made at home and repaired at a health facility. From the above experience, a Mutwa in Kisoro has the health facility to rely on for his well being. I took some time to look at the health services available and accessible to these people.

Nyarusinza health centre Three is the closest health facility – about 7 kilometers from Ruceri village. It’s a government health facility but just like many other public health centres, it has several challenges that negatively impact on its capacity to deliver and consequently it has failed to attract the confidence of the community including the Batwa.

Perhaps the biggest gift to the Batwa came in form of the Combating Child Mortality Among Batwa in Kisoro district (CCMB) program- an initiative of St. Francis Hospital popularly known as Mutorere hospital and its partners.

The arrangement under this program is that when a Mutwa falls sick or wants to access any health service including but not limited to testing, screening and child delivery, he or she simply walks to Mutorere hospital, is served for as long as it takes and the bill is footed by the hospital and its partners in this program.

For the pregnant mothers who definitely have to spend a couple of days as well as those who are admitted, the project takes care of their feeding as well as the feeding on the attendants for the longevity of one’s stay at the facility. It’s this treatment that makes the Batwa feel free, access quality medical care, stay healthy and hope for the best. “The services at Mutorere are excellent, a reason why we are healthy and few mothers and children die during and after delivery”, Nyiraneza Mereth, a resident of Rubuguri in Kisoro district who I found at the hospital attending to her pregnant aunt told me.

This facility is about 5 kilometres away from Kisoro town. Depending on the Batwa community you are from, people trek a good distance to come here. Ruceri village is about 30 kilometres away and many people from this village also walk to get service at Mutorere while a few afford parting with over 6000 shillings hiring a motor cycle for a single route journey for one person.

Ssendegeya Emmanuel aged 29 years comes from Birara Batwa Community which is about 27 kilometrers from this hospital. He is a carpenter but I found him at the hospital because he is on TB treatment.

The day in found him at this health facility (10^th December, 2015), he had been there for six days with his wife attending to him. “I have been here with my wife for close to a week now. All is well. I get medicine and am regularly checked on by the professionals. My wife and I get food from these people (the hospital management). I hope for a quick recovery and hope to be discharged soon”, a weak toned Ssendegeya told me from his hospital bed in the isolation wing.

 

CCMB Project at a Glance

Credited for changing the lives of the Batwa, this project started in 2009.

According to Katto Justine- registered nurse and midwife who is the project coordinator the need for this initiative emanated from their observations and findings during the numerous community outreach projects they used to carry out as a hospital. “We found out that the Batwa are poor and they had difficulties accessing health services. Mortality was high in the Batwa communities especially among women and children. It is this that made us think of ways to help these people” she narrated.

In 2009, the hospital patterned with CARE- an international NGO to scale up community health out reaches in the Batwa communities. “We started with 12 community outreach centres. During these outings, we emphasized the need to visit hospitals, did a number of tests, treated diseases and also carried out monitoring of pregnant women”, She explained adding that the drive saw a surge in the number of Batwa visiting health facilities after some time. With sensitization, Katto elaborates, the Batwa have improved on sanitation and personal hygiene though there is much to improve on.

In 2011, the CARE partnership came to an end and Sustain for Life- another NGO came on board. This organization foots the hospital bills and also pays for the food rations given to the patients and their care takers.

The hospital now receives about four Batwa pregnant women per month seeking antenatal services. As of today, 20 Batwa women are taking family planning services from St. Francis hospital. “Though the numbers are low, it’s a big step and an achievement- considering that we started from zero”, an enthusiastic Katto- an enrolled nurse by profession noted.

 

Outstanding Health Challenges Among the Batwa

As already highlighted, sanitation is still a huge health challenge among the Batwa. With poor sanitation, this community is not at all safe from diseases.

Due to the Batwa’s Landless nature, food is still a huge mountain to climb. Consequently, malnutrition cases among the Batwa children are high. The most affected are children. “Due to poor shelter and clothing, we get many cases of pneumonia among the Batwa children”, Katto elaborated but added that under the CCMB project, they are now giving mothers free baby clothing kits.

According to Katto, another huge health challenge is HIV and Positive living among the Batwa. Like any other community in Uganda, the Batwa are also affected by HIV/AIDS.

Some people are positive but very few know their HIV status. According Katto, the CCMB project encourages HIV testing during the community outreaches but very few test to know their status. Those who test positive, she adds are enrolled on treatment and closely monitored. However, she notes that positive living is a big challenge. “Adherence to treatment is a huge challenge because the Batwa are always on the move. Because of little food, taking medicine is difficult and positive living in now a huge challenge.

Traditions like sharing of women have increased the spread of HIV and other sexually transmitted diseases”, Katto further narrated to me during our detailed discussion in her office at St. Francis hospital- Mutorere.

Birth rate among the Batwa is high and uptake of family planning services is still very poor. According to Katto, after years of sensitization, they have registered 20 Batwa women who are using family planning. “This is a small number but a positive step”, she observes.

Despite all this, the Batwa are moving forward and the future looks brighter. Peninah Zaninka- the head of the Organization for Batwa Development in Uganda (OBDU) observes that the Batwa have come from far and despite the challenges, they hope for a better tomorrow. According to Zaninka, the key to making the lives of the Batwa better is solving the land question- in other words; getting the Batwa Land to stay on and do developmental projects.

 

Batwa Resettlement Efforts

For over the years, non- governmental organizations have tried to resettle the Batwa. Organizations like the Organization for Batwa Development in Uganda (OBDU), ADRA Uganda, CARE International, Bwindi Mugahinga Trust, the Adventist church and may others have bought land in several areas of Kisoro, Kanungu and Kabale districts where they have resettled some Batwa.

The Batwa in these areas are living in decent houses and have land for cultivation. As of December 2015, the Batwa had been resettled in Kabahenda, Butoobo, Kamugyemani all in Busanza Sub County- Kisoro district, Rubuguri, Nteko, and Nyakabande in Kisoro district.

In Kabale district, the Batwa have been resettled in Karengyere in Muko, Murambo, Ekinyarushengye and in Rubindi. In Kanungu, the Batwa have been resettled in Buhuma where they live today.

When I visited Kabahenda, Rubuguri, Nteko, Murambo, Karengyere and Buhuma communities where the Batwa have been resettled, I observed that the people here are living a more organized life, fully integrated into the community, sanitation levels are better, they are engaged in cultivation and they are more positive about life compared to those in communities like Kisoro Town, Ruceri village and other areas where the Batwa are living as squatters.

Voices of the People

Winnie Mukandinda- Land rights Officer at OBDU:

 

The Batwa are such an interesting group of people with potential to do a lot. They have come from far and the future looks bright for them. Government of Uganda ought to come out now and work with the non- governmental organizations to address challenges of the Batwa especially Land. They were evicted from the forests without compensation and this injustice ought to be corrected.

Milton Mutabazi Bazanye, Chairman Kisoro District (2011-2015); As a leader I wish to see all the Batwa settled. As a district we have plans to resettle them but this is a long term project. We salute organizations that have really helped to resettle the Batwa much as more are still squatting. If the Batwa get land like those who have been resettled, we will be able to see their productivity and poverty among them will be history.

 

Sam Byibesho- the Kisoro Municipality Mayor (2011-16); When you compare the Batwa living in Kisoro town with those living in rural areas especially those who have been resettled, you realize that we need to get these people where they can call home.

Addressing the Batwa land question is key but this needs all the stake holders to come on board. “ I propose that to get the Batwa on the same footing with the rest in development, after handling their land needs, we should come up with an affirmative action to economically empower them”, he notes.

 

Nyamihanda Alice- an Educated Mutwa: The Batwa have been marginalized for long.

“We deserve better than this”. Am glad many Batwa children are now accessing education, many people are now engaged in income generating projects, the Batwa now access quality health care and of course the support from the NGOs is good.

However, one worrying aspect is the sustainability for some of these projects like the Health project at Mutorere hospital. “As a Mutwa, I believe we need a representative in Parliament who can be our voice and articulate our issues”, the 27 year old who dreams of representing her area in Parliament notes.

 

Ronah Ritah Ninsiima- The Kabale District Woman Member of Parliament (2011-2016): As leaders we must consider the plight of the Batwa people and see how to help them settle in the community.

They must also benefit from government programs like Operation Wealth creation, NAADS, Youth Livelihood fund but if they are still landless, they might not and they will unfortunately stay poor.

 

Tibamanya William Kisoso- The Mbarara district speaker (2011-2015);

I have visited families of the Batwa living in Mbarara district (Nyakayojo Sub County). The truth is, these people need to be loved, treated well, welcomed and they must enjoy every public good like all other Ugandans. Because of the historical injustice they faced, an affirmative action is needed to improve the situation they are in today.

 

John Justice Tibesigwa- Senior Warden Bwindi Impenetrable National Park; Today, we enjoy a good relationship with the Batwa. Many of them operate as tour guides in the national park where they get income, the areas neighboring the park where some Batwa stay benefit from the revenue sharing program. We are working with the Batwa leader and the district leadership to identify their former worshipping and ancestral places so that we preserve these places and also allow Batwa access to these important places.