Looking back, Otto remembers struggling to breathe when he was as young as four. Exertion would make him cough, and the coughing fits would go on and on. Growing up in a family of eight children in a village in northern Uganda, he would try to run and play with other kids. But usually he ended up collapsing or needing to rest.
At age ten, he passed out while riding a bus to a mill, where he was supposed to grind maize for his family. By the time he was a teenager, running 100 metres would wipe him out. His heart would race and he would sweat profusely. He was often dizzy.
Over time, Otto sought medical help, and he received treatment – for both bronchitis and malaria. But he never really got better. Then in March 2017, a doctor took ultrasound images of his heart and finally gave him a diagnosis that explained everything: he had rheumatic heart disease – an irreversible illness caused by group A Streptococcus bacteria. He was 22.