Aggie Patricia Turwomwe
I keep sitting up straight eveytime i replay sentences made by Dr. Francis Xavier Kasujja who said things I have never heard a Ugandan doctor say out loud. And once you hear them, you cannot unhear them.
“They Told Me They’d Rather Have HIV”
Let that sit for a second.
Francis has been a public health researcher for 15 years. He has sat across from patients with diabetes in study after study, in Uganda, in Tanzania, across the region. And in three separate studies, patients looked him in the eye and said they wished they had HIV instead of diabetes.
Not because HIV is a good thing. But because HIV, in Uganda, has a system. It has funding, organised clinics, patient files going back 30 years, drugs available for free at your nearest health facility.
HIV care in Uganda is, by many global measures, excellent.
For Diabetes, We are, in Francis’s own words, ‘still learning how to provide care for it.’
And the complications; foot amputations, blindness, strokes, heart attacks, impotence are gruesome in ways that HIV, with ARVs, largely no longer is.
I sat with that for a long time. Because it tells you everything about where we are as a country. We fought one battle so hard and so well that we forgot another one was quietly starting.
The Epidemic You Are Already Living In
Here is a number that should stop you cold. 1 in 3 adults in Kampala has hypertension. Not nationally. Not in some high-risk group. In Kampala. The city most of us reading this call home, or visit regularly, or grew up in.
Count the people in your office. Count them at church on Sunday. One in three.
And diabetes, which used to affect about 1 in 100 Ugandans, has doubled in the last 10 years.
Doubled.
In a decade. The trajectory is not slowing down. It is accelerating because our lifestyles are accelerating in exactly the wrong direction. This is a right now problem.
The Rolex Moment
I will be honest. When Francis said the Rolex is fast food, I laughed for those who eat it everyday. Especially university students. Some have subscriptions to a rolex guy, there is one right outside the gate, it costs next to nothing, and it has an egg and vegetables in it. How bad can it be?
Very bad, apparently.
The oil it is cooked in has been heated and reheated all day, past its smoking point, accumulating compounds that are deeply damaging to the body. And most young Ugandans, the ones who are supposed to build this middle-class economy, are eating them daily, sometimes twice a day, sometimes on account at the end of the month.
Francis was not judgmental about it. He understood exactly why it happens. You are tired. You are busy. Cooking for yourself feels impossible. And the Rolex is right there. But he was clear that these choices compound. You do not feel them for 10, 20 years. And then one day, you do, and by then, reversing them is extremely difficult.
What This Has to Do with the Middle-Class Economy
Here is where I want you to stay with me, because this is the part that connected everything.
Uganda’s president has described the country as a “pandemic economy” meaning we have actually grown stronger through the lessons of the health crises we have faced. HIV taught us how to build systems. COVID reminded us that research investment pays off. And Francis’s work is the clearest example of what that looks like in practice.
His team developed a model, community-based integrated care, where a nurse and a village health team member bring treatment to a meeting point in the community. Patients spend two hours there instead of nine at a hospital. They get care for HIV, diabetes, and hypertension in one visit. They go home. They go to their gardens. They do not lose a full day’s income.
The study was published in The Lancet, twice. It contributed to the Ministry of Health adopting a new approach to care. And it is a proof of concept that you can build a world-class health intervention from within Uganda, for Uganda, that the whole world notices.
That is what a middle-class economy looks like in practice. Not just GDP numbers. Not just new buildings. It is a population healthy enough, informed enough, and cared for well enough to be productive. To innovate. To show up.
A sick population cannot build an economy. A well population can.
The 4:30 AM Truth
Near the end of the conversation, Francis says something that I have not stopped thinking about.
He admits that even he, a public health researcher who knows exactly what diabetes complications look like, sometimes lies in bed at 4:30 AM and says “No way.” No way am I getting up. No way am I exercising today.
And then he gets up anyway.
Because he has seen the foot amputations. He has sat across from patients who would give anything to go back and make different choices. And he knows, in a way that most of us are spared from knowing, exactly what the cost of those small daily surrenders adds up to.
“You choose your pain. Prevention is painful. But the pain of having your foot amputated is far worse than waking up at 4:30.”
What You Can Actually Do
Francis does not leave you feeling helpless. That is one of the things I appreciated most. He is not the kind of researcher who diagnoses the problem and disappears. He gives you something to hold.
- Eat a real diet. Diverse, balanced, mostly unfried. The healthiest foods in Uganda are still, thankfully, the cheapest.
- Move your body. Walk when you can. Do the yoga. Do the stretching. Do not wait until it is medically required.
- Know your numbers. Get your blood pressure checked. Get a diabetes screening. These things are available and affordable. What is expensive is ignoring them.
- Listen to the research. Uganda is producing world-class health research. Read it. Share it. Demand that your leaders use it.
One Last Thing
At the very end, i call him “doctor” and he gently pushes back, he does not want to lean on the title. But i insist, am i right to?
I think there is something important about a man who has done this level of work, published in the world’s best journals, contributed to national health policy, spent 15 years in rooms with sick people asking how to make things better, and still shows up at 5 AM to exercise, still eats his beans, still mentors young researchers, still makes time for a podcast to talk to ordinary Ugandans.
That is not a title. That is character.
And Uganda needs more of it, in labs, in clinics, in policy rooms, and honestly, in all of us.
Share it with someone you love. And maybe, just maybe, skip the Rolex tonight.
And while at it, what do you think it will take Uganda to achieve a middle class economy?
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