“I am lucky that I came early”. These were the words a young lady exclaimed. I met her in one of the government health centers, which I visited in December 2021. Almost four months ago, the young lady had taken a Covid-19 test together with her husband and her children at this health facility. All tests turned out positive and the whole family had to confine itself under the concept of home-based care and treatment. After finishing the treatment, they all returned to the health center for a confirmatory test necessary to lift the confinement and return to their normal life in the community. To the disappointment of the family, there were no test kits at the health facility. The health workers kept on encouraging them to wait for the test kits and kept on promising them they would arrive soon. At the time I met her, she finally had heard that test kits had arrived—after one month and three weeks of confinement. Her husband had refused to come, because he had become tired of waiting and already had resumed his work.
In our conversation, this young lady could not hide her excitement of getting tested that day, because other people who came after her were sent back home because the health workers said there were not enough test kits. The case of this young lady is also one of the many cases I encountered during my research showing how the stock-out of rapid diagnostic tests for Covid-19 deepens the existential insecurities in rural Uganda.
PCR tests for Covid-19 are relatively expensive and thus difficult to access for the majority of Ugandans living in the rural areas. Hence, the use of testing to contain the spread of the virus has been rather limited throughout the pandemic. Initially, people test primarily when it was a requirement, like for international travels. Consequently, the data that is produced through testing show very little about the scale of the Covid-19 pandemic nor the effectiveness of the response measures in the county.
The introduction of cheaper RDTs has improved the accessibility of Covid-19 testing. Especially in rural health facilities, there has been an increase of the use of RDT to test for Covid-19. But, more testing in the form of RDTs has not reduced the many unknowns in the pandemic. In particular, the introduction of RDTs has not reduced the unknowing that comes after the knowing of a test result, as Rehema Bavuma put it aptly.
According to people’s understanding of the regulation, they can return to their normal lives in the community after a confirmatory test proves their recovery by showing negative result. Covid-19 testing implies more testing and hence more RDTs. As an interview showed, a confinement turns into an existential drama and dilemmas, when RDTs are out of stock at health facilities as the following informants told us.
„The in-charge kept on telling us that the test kits have not yet been brought. They kept on tossing us like that for about 1 month and 2 week. We were at home all the time. We felt that staying at home, while there are other things need to be done, was quite unfair. My husband has refused to come because we kept calling on phone and the in-charge kept telling us that the test kits were not there.“
My informant elaborated the gravity of the lack of Covid-19 test kits for them. She lives in rural settlement and her livelihood depends on agriculture and small economic activities. Making a living was heavily disrupted by the shortage of RDTs that lead to the prolonged confinement. Crops and vegetables keep on growing until time comes to harvest and go to the market to sell. Without a confirmatory test she felt, she could not leave the confinement and attend the market. Everything started to rot as she told, graphically.
„There was no selling in the market, and in the community; there was no one to buy and all of them got spoiled. Especially tomatoes got rotten, they don’t wait, they don’t say let me stay without ripping, because they are not picking me. The size of the garden was about 25 meters by 25 meters, and all the crops including cabbages got rotten, and the African eggplants got spoiled.“
As a result, she also lost the income that she needed now and for sustaining her farming business: “money just disappeared and even tomorrow it is still not there – yes.”
For my interviewee the confinement became a trap. With little choice, people confine themselves within the boundaries of their homes, water points, and farms. This confinement constitutes a significant burden as people withdraw from interacting socially, and economically, because RDTs are out of stock.
Another way, the stock-outs of RDTs turns the Covid-19 confinement into a trap is by making it prolonged beyond the gazette period of treatment time (approximately 14 days). As people wait for RDTs to arrive at the health center, customers, neighbors, and even relatives avoid visiting them. Even the vegetables, as our informant told us poignantly, do not wait to be ready for people to harvest and sell them.
The shortages of RDTs for Covid-19 are not a surprise. Stock-outs are not the exception, but the norm in the Ugandan public health system. The confinement of Covid-19 patients vividly underlines how stock-outs make it impossible to adhere to rules and regulations for the management of a disease. They disrupt routines and policies, which are premised upon the assumption that commodities are constantly available to do for example a confirmatory test.
Surprisingly, following Covid-19 positive test restrictions amidst stock-outs among the people living in the rural communities are comparatively more conscious about the SOPs conditions and stick to social confinement measures. And that are current common norm in the rural settings. For them, it is a practice to confine themselves within their home for the sake of preventing further spread of the disease. Whereas, people in the urban communities appear to be less conscious in following SOPs which has been defined by the government and Ministry of health. It is either the level of awareness on Covid-19 or an indicator of economic survival amidst the pandemic, yet the people in rural communities are abiding by the rules to halt the spread of Covid-19.
So far the community outcry is relatively low. It is likely that the issue of inadequate supplies of RDTs remains hidden and silent. However, the shortage of RDTs points to another problem. RDTs are less reliable than PCR tests such that a positive RDT result should be ideally confirmed by a PCR test. Especially, instructions to confine one’s self based on a positive RDT result should be ideally confirmed by a PCR test, or at least by another RDT, which is not possible due to the frequent shortage of RDTs and the costs of PCR tests. Moreover, the results of the RDTs are not even part of the official reporting systems. National Covid-19 statistics rely only on PCR test results. RDTs do not necessarily fill the gap of the unknowing produced by the lack of unaffordable and inaccessible PCR tests. To the contrary, they amplify the unknowing that comes after the knowing of a test result. RDTs essentially require more testing to get more reliable results, inform decision making and moreover to provide a more reliable account of the situation in the country which presumes a stable and sufficient supply of these commodities.