TWAIBU WAMALA once coordinated care for 180,000 drug users. Now he watches helplessly as the system collapses around him, writes GEOFREY SERUGO.
In a humid Wednesday afternoon in Kampala’s Makindye suburb, I find Twaibu Wamala seated in a near-empty office, cloaked in silence. Dust clings to unfinished reports. His phone, once a hotline of desperate need and urgent care, hasn’t rung in hours.
Treatment schedules lie obsolete on his desk ghosts of a system that once pulsed with life. Just months ago, this room thrummed with voices and movement staff coordinating critical care for Uganda’s most marginalized. Now, it’s a mausoleum of broken promises.
“I used to know every number— how many doses, how many lives,” Wamala says softly, fingers grazing the brittle pages of patient ledgers.
“Now I just count the days since the money stopped… and the people who’ll die because of it.”
As executive director of the Uganda Harm Reduction Network (UHRN), Wamala had stitched together a fragile lifeline for people who use and inject drugs. Under his stewardship, UHRN reached over 180,000 clients through 68 grassroots organizations. It wasn’t just care they provided it was dignity in a country that preferred to look away.
“Twaibu was our shield,” recalls Ronald Ssemakula, a former peer educator. “When the police rounded up drug users, he came with lawyers. When clinics turned us away, he fought. Now? There’s no one.”
THE DAY IT ALL FELL SILENT
The collapse began quietly—an email with no warning. On January 20, 2025, U.S. President Donald Trump began his second term by dismantling key global health programs, including the U.S. Agency for International Development (USAID), a pillar of support for harm reduction in Uganda.
Just days later, Wamala received notice: all funding for Uganda’s Opioid Agonist Maintenance Therapy (OAMT) had been frozen. No warning. No wind- down. His hands tremble slightly recalling that day.
“How do you tell someone their job saving lives ends now? How do you explain to a mother that her son’s methadone will stop tomorrow?”
Desperate messages flood his inbox pleas from clients he once had answers for. Now, his replies are heartbreakingly simple: I’m sorry. “Before, I had tools. Options,” he says, showing a text from a former patient.
“Now? I’m just a man with no medicine.”
The emotional toll is etched in his face. Once vibrant and energetic, Wamala now moves like someone carrying too many ghosts. His sharp dress has softened into weary creases, his laughter dulled by despair.
The collapse of these programs has triggered a public health emergency. Without daily methadone, people face excruciating withdrawals. With harm reduction centers shuttered including the clinics at Butabika, Makindye, and Mbale hundreds are left to detox on dirty mattresses, or not at all.
Already, UHRN has recorded over 200 overdose crises, 456 cases of severe withdrawal, and three confirmed deaths. One patient clings to life in intensive care. Stockouts of essentials—naloxone, needles and syrings, self-testing kits only worsen the spiral.
What wounds Wamala most is knowing the solution was working? His programs had slashed HIV transmission among drug users by over 50%. Uganda was on the cusp of opening its first supervised injection site.
“We had the proof,” he says, slapping a faded report on the table. “We had numbers. We had lives saved.”
He gestures to an empty cabinet, a void where hope once lived. And yet, every morning, Wamala still shows up. He checks emails, meets with officials who offer sympathy but not support. Most of his staff are gone, scattered in search of work.
“If I stop,” he whispers, “then it’s really over.” In his quietest moments, it’s the names that haunt him. Peter, just 19, who overdosed two weeks after being cut off from care. Mariah, now adrift in a rehab center without UHRN’s legal backing.
“I know this isn’t my fault,” Wamala says, his voice trembling. “But when Peter’s mother wails at his funeral… when I see my team driving boda bodas to survive… what use is logic?”
As night falls, he locks the empty office behind him. He’ll return tomorrow. Not because there is work— but because walking away would mean surrendering to the unthinkable: that after building hope brick by brick, he is now powerless to stop it from crumbling.
A FLICKER OF LIGHT
In a twist that feels almost surreal, treatment services have now resumed— albeit under a temporary waiver. It’s a lifeline thrown to a drowning system, and Wamala clings to it with quiet hope. But the future remains uncertain.
“We’re holding on,” he says. “But we don’t know what will happen when the days of the waiver are done.”
For now, the doors are open, methadone is flowing again, and clients are returning some gaunt and trembling from weeks without care, others clinging to the fragile belief that this time, the system won’t vanish beneath their feet.
“We pray,” Wamala adds, his voice low, “that our program continues to be supported. It has saved the lives of many Ugandans who use and inject drugs. Across this country, we’ve seen transformation. We just need the world not to turn its back again.