It’s not clear what the British architect of Uganda’s Parliament envisioned when he designed the building shortly before independence in 1962. Sitting askew on a hill in downtown Kampala, with its angular white columns it could be a modernist African Parthenon. But inside, it’s a warren of hallways and balconies with AK-47-toting security guards lurking everywhere. On the wall outside the visitors’ gallery looms a row of painted portraits of the thugs and generals—Idi Amin, Milton Obote, and others—who have ruled this country during the past fifty years, alternating with a professor and a lawyer who were ousted from power within months. “This one toppled that one, and that one toppled this one…,” a tour guide explained as he showed me around.
I teach and write about public health and have been coming to Uganda for twenty years. In August 2013, I spent a few days watching videos of old debates in the basement archives of Parliament. In 2012, Uganda passed an important public health bill, and I wanted to find out more about one of the MPs who had worked on it. It was a quiet Saturday morning when I found the tapes I was looking for. As I watched the scratchy VHS recordings, the technician who had kindly agreed to open the studio for me on a weekend sat in the adjoining anteroom working at a computer. Most of the politicians in the videos were men in dark suits, some with spectacles creeping down their noses. Some spoke with passion and clarity, pounding the air with their fists; others—the scoundrels, mainly—droned on and on.
After a few hours, the Speaker of Parliament, a formidable Ugandan woman in a British-style judicial wig, called on a twenty-four-year-old MP named Cerinah Nebanda, the person I was interested in. Before I knew it, the technician was standing beside me, his eyes glued to her as she spoke. Nebanda was beautiful, in the zaftig African way, with a warm face, a powerful voice, extraordinary charisma, and, it would turn out, unusual courage. As she shook her finger and leaned over to emphasize a point, it was impossible not to watch her.
Nebanda died in December 2012, poisoned, some of her parliamentary colleagues maintain, by Ugandan government operatives. Then, in August 2013, an online magazine published an interview with General David Sejusa, the former coordinator of Ugandan intelligence services, who had fled into exile in the UK in May 2013. The general claimed that Nebanda, and many other prominent Ugandans who also died from mysterious illnesses or in sudden accidents, had been deliberately killed on “orders from on high”—meaning at the direction of Uganda’s President Yoweri Museveni, who has ruled this country for twenty-eight years.1
During the year following Nebanda’s death, I conducted scores of interviews and read through hundreds of news articles, reports, and parliamentary transcripts to try to find out whether this was true, and, if so, why the government would want this young politician dead. I found that around the time of the Arab Spring in 2011, a movement demanding democratic reforms emerged in Uganda too, but it was systematically quashed by Uganda’s leaders. Those who claim that Nebanda was assassinated maintain that these leaders wanted to intimidate anyone considering a challenge to their grip on power. Meanwhile, with the assistance of extremist American evangelicals, Museveni’s family has been secretly funding pastors throughout Uganda to frighten people into believing their problems are due to an international conspiracy of homosexuals bent on sodomizing their children. Thus, Museveni has been using gays the way past tyrants have sometimes used Jews: to divert popular attention from their crimes.2
One of the issues with which Nebanda was most engaged was improving public health. Uganda has some of the worst health statistics in the world, despite having received billions of dollars in foreign aid for health services, and having been host to thousands of advisers—including me—on everything from malaria control to hospital construction.
This wasn’t always the case. I was originally drawn to Uganda because of its remarkable medical history. Long before colonial times, the people of this region had their own gods to distinguish plague from tuberculosis, and performed successful Caesarian sections—a rare operation even in Europe before the twentieth century. The natives were in turn fascinated by missionary medicine. When Albert Cook, the doctor who founded Uganda’s first hospital in 1897, restored the sight of a man with cataracts, the ecstatic patient declared that Cook must be God himself. The first medical school opened in British colonial Uganda in the 1920s and competition for a place was so tough that “to get in you had to be a genius,” according to one young aspirant. By the 1970s, it was almost as safe for a woman to deliver a baby at Mulago Hospital in Kampala, the nation’s largest, as at some American hospitals at the time.3 Ugandan scientists helped pioneer treatment for childhood cancers and malnutrition and the mass immunization campaigns that UNICEF would later promote throughout the developing world. When Singapore was looking to reform its own health care system in the 1960s, it sent a delegation to Uganda.
Today, this system is a shambles. Bats, snakes, and other wildlife have taken up residence in once-functioning rural clinics. I have seen fecal material rain down from the crumbling ceilings of operating theaters. Power cuts and water shortages in hospitals kill thousands of patients each year, and emergency operations on pregnant women are sometimes carried out by the light of torches made from burning grass. A decade ago, the UK government funded the construction of scores of new hospitals, but the Ugandan government neglected to staff them, and some are now hideouts for thieves.
In 2012, women were seven times more likely to die in childbirth at Mulago Hospital than when Idi Amin was president forty years earlier.4 Uganda loses one child to malaria every seven minutes, the highest death rate from that disease in the world, and in 2013, scores of people died of famine in this lush, fertile country for the first time in living memory, not because of food shortages, but because the government failed to provide the resources to send food where it was needed. The notorious Ebola virus, which spreads to human beings from monkeys and causes massive internal bleeding, kills scores of people every year or two. The outbreaks could be prevented with simple surveillance of animal populations, but the government doesn’t bother to maintain such a system. “Villages can be strewn with dead monkeys for months,” Margaret Mungherera, head of the Uganda Medical Association, told me. “No one does anything.”
The cause of this mess is no mystery. Ever since Uganda began receiving generous amounts of foreign aid two decades ago, senior Ugandan politicians and civil servants have been stealing virtually every shilling they can get their hands on. In 1995, the World Bank recapitalized the defunct Uganda Commercial Bank with a loan of $72 million. Museveni then sold it to a consortium that included his own brother for $11 million. The remaining $61 million has never been accounted for.5 A year later, the World Bank provided Uganda with a multimillion-dollar loan to construct fifteen irrigation dams. Museveni’s agriculture minister reported to Parliament that the dams were nearly complete, but a few weeks later, an investigative team confirmed that they did not exist. A Nigerian contractor was blamed for having stolen the money, but most Ugandans believe their own leaders took it. Nevertheless, despite these and other scandals, the World Bank lent Uganda ever more money, and even praised it as a model of development from which other poor countries could learn.6
The US, Japan, and Europe also poured in aid, and as they did, ever more outrageous scandals ensued. Money intended for children’s vaccines ended up in the First Lady’s office; millions intended for forestry projects, AIDS and malaria sufferers, road building, and assistance to victims of the notorious warlord Joseph Kony turned up under ministers’ beds, in flower pots in the prime minister’s office, in Las Vegas casinos, in personal bank accounts, and in heaps on the floor in President Museveni’s official residence.7 Millions more disappeared into the accounts of nonexistent schools and hospitals, “ghost” soldiers and pensioners, and such initiatives as the “Rabbit Multiplication” project that perform no activities at all.
Cerinah Nebanda was one of a group of MPs trying to do something about this mess. She spoke out against corruption and joined a parliamentary movement to shift money from various ministries, including the lavishly funded Defense Ministry, to increase the salaries of government doctors. Uganda pays government doctors only $350 per month, far less than their counterparts earn in much poorer neighboring countries. Even in Africa, it’s impossible to support a family on this salary. As a result, thousands of Ugandan doctors have emigrated and some of those who remain live in slums. Only half of Uganda’s health workers show up to work on any given day, and nearly half of those are so ill-qualified they can’t diagnose pneumonia.8 Some have stolen donated medicines from public pharmacies and refused to treat patients without a bribe, even in emergencies. Court testimony and newspaper reports describe doctors standing around chatting and watching soccer games while women under their care died in childbirth, screaming for help.
The MPs behind the bill understood that raising doctors’ salaries alone would not save Uganda’s health system, but it was a crucial first step. President Museveni was firmly against the move—his prime minister claimed that cutting the defense budget would endanger national security—but popular support was overwhelming and the bill passed in September 2012.
Nebanda was still a university student when she was introduced to her MP, Emmanuel Dombo, in 2009, but he immediately recognized her political gifts. Uganda’s Parliament has special seats reserved for women. Every county has an ordinary MP, who may be either male or female, usually the former, and a woman MP.
Dorothy Hhuya, then the woman MP from Butaleja, the district Dombo represented and where Nebanda spent most of her childhood, was a friend of Museveni’s and an officer in his National Resistance Movement party, but she had lost touch with her constituents. For years she had been promising to bring development projects to Butaleja—once an active trading center on a railway line that brought in imports from the Kenyan coast, now a wasteland of dilapidated factories and roads all but impassable in the rainy season. Most people survived by growing their own food on small plots of flood-prone land. When they managed to grow cash crops, well-connected traders manipulated the prices so they earned almost nothing. Hhuya’s message—that since she was close to the president, people should vote for her if they wanted development—sounded increasingly hollow. “We felt we were being conquered, not governed,” a local from the area told me.
Elections were scheduled for early 2011, little more than a year away, and Dombo, who was also a member of Museveni’s NRM party, was looking for a candidate to run against Hhuya in the primary. When he met Nebanda, he knew he had found her.
1 Henry D. Gombya, “Nebanda, Wapa, Mugalu & Others Died from Orders on High,” The London Evening Post, August 29, 2013. ↩
3 According to Dr. Anthony Mugasa, reproductive health adviser of the Uganda Ministry of Health, the maternal mortality rate at Mulago in 1972 was 71 per 100,000 live births. Interview with Dr. Mugasa, July 2013. ↩
4 It is now 498 per 100,000, compared to 71 per 100,000 live births in the early 1970s. Interview with Dr. Mugasa, July 2013. ↩
5 Joel D. Barkan et al., “The Political Economy of Uganda,” a background paper commissioned by the World Bank, July 6, 2004, p. 64. ↩
6 Uganda’s Recovery: The Role of Farms, Firms, and Government, edited by Ritva Reinikka and Paul Collier, World Bank 2001. See the introduction by Collier and Reinikka. ↩
7 Ambassador Jerry Lanier to US Secretary of State Hillary Clinton. CABLE: Uganda’s all you can eat corruption buffet. January 10, 2010; Human Rights Watch: Letting the Big Fish Swim: Failures to Prosecute High Level Corruption in Uganda. October 2013; Anthony Wesaka. Mukula claims giving Gavi Fund money to Janet Museveni. The Monitor (Uganda). November 13 2012; Dear Jeanne, How soldiers stole State House money. The Monitor (Uganda) November 24 2013. ↩
Henry D. Gombya, “Nebanda, Wapa, Mugalu & Others Died from Orders on High,” The London Evening Post, August 29, 2013. ↩
According to Dr. Anthony Mugasa, reproductive health adviser of the Uganda Ministry of Health, the maternal mortality rate at Mulago in 1972 was 71 per 100,000 live births. Interview with Dr. Mugasa, July 2013. ↩
It is now 498 per 100,000, compared to 71 per 100,000 live births in the early 1970s. Interview with Dr. Mugasa, July 2013. ↩
Joel D. Barkan et al., “The Political Economy of Uganda,” a background paper commissioned by the World Bank, July 6, 2004, p. 64. ↩
Uganda’s Recovery: The Role of Farms, Firms, and Government, edited by Ritva Reinikka and Paul Collier, World Bank 2001. See the introduction by Collier and Reinikka. ↩
Ambassador Jerry Lanier to US Secretary of State Hillary Clinton. CABLE: Uganda’s all you can eat corruption buffet. January 10, 2010; Human Rights Watch: Letting the Big Fish Swim: Failures to Prosecute High Level Corruption in Uganda. October 2013; Anthony Wesaka. Mukula claims giving Gavi Fund money to Janet Museveni. The Monitor (Uganda). November 13 2012; Dear Jeanne, How soldiers stole State House money. The Monitor (Uganda) November 24 2013. ↩