Things fall apart at Mulago Hospital

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Kampala. Mulago Hospital has run out of reagents and subsequently suspended laboratory investigations for common infections, expectant women have to buy own sutures to give birth by caesarian while surgical procedures are being deferred indefinitely amid sporadic supply of oxygen to theatres.

The collapse in basic services at the national referral hospital, according to our investigations, began manifesting last November but reached crisis proportion in May, this year, prompting senior doctors to formally protest to the management and the parent Health ministry.

Patients at both Kawempe and Kiruddu hospitals, the two satellite wings of Mulago Hospital that is presently under renovation, said otherwise free diagnostic and curative services are being offered to only those who can buy good health.
The health workers this newspaper spoke to blamed Mulago hospital management, but the institution’s executive director Dr Baterana Byarugaba in turn attributed the deplorable situation to chronic under-funding by the government.

He said they require Shs100b to offer optimum service yet Finance ministry gives them only Shs13b each year for essential drugs and health commodities.
Last Tuesday, a make-or-break meeting at Kawempe hospital between Dr Byarugaba, senior medical officers and surgeons ended without a solution to relieve patients in pain and distress.

Ms Namayanga Teddy was referred from Kitebi Health Centre III in the city suburb of Mutundwe, with a post-birth third-degree perineal tear, requiring immediate stitching to prevent bleeding. Several hours later, on Monday, the required corrective surgery was pending because she was instructed to buy out-of-stock theatre items essential for the procedure.
It cost them Shs24,000 from a nearby pharmacy, her attendant said, but the procedure was still delayed further because health workers told them that the theatres were full.

The stock-out of drugs and basic supplies has given rise to a black market where health workers have the discretion, for instance, to charge patients anywhere between Shs85,000 to Shs300,000 for buying necessities for surgical procedures.
“All major things required for a surgical procedure; sutures, gloves and even gauze are not there. There are no medicines; so patients have to buy. Some of our colleagues are taking advantage of the situation,” a doctor said on condition of anonymity because they were not authorised to speak to the media.

Besides medicines, patients booked at the national referral hospital are required to buy syringes, intravenous fluids, giving sets and cannulas as well as anaesthetics.
The facility’s Private Wing where a baby delivery by C-section costs about Shs2.6m, has started demanding patients to provide similar basic theatre supplies, according to one staff member.

Mr Nelson Obote, the administrator of Kiruddu, home to Mulago’s Internal Medicine directorate, told this newspaper that they no longer do some laboratory tests due to “lack of reagents”.
Affected examinations include, among others, complete blood count that helps to detect disorders such as leukemia and anaemia or other infections. Laboratory investigations for urinalysis to spot diabetes, urinal tract infection and kidney diseases have been suspended alongside diagnosis for Hepatitis B and C, syphilis and tumour markers for cancer detection.

“The patients think we don’t want to work because we want money, but the truth is we don’t have the medical supplies yet we will be individually liable to the professional regulator if something goes wrong during a procedure due to stock-outs,” said another doctor.
The fear of the health workers stems from a recent incident when one of their colleagues, a lecturer at the Makerere University College of Health Sciences, had to leave in frustration after being fined about Shs30m over the death of a patient arising from inadequate medical supplies.

At last week’s meeting, the senior Kawempe Hospital team reportedly repeated its earlier demands to Dr Byarugaba that he makes an official admission of the unprecedented crisis and publicly announce emergency levies so that patients seeking treatment at the facility are prepared to pay.

On Monday, a woman in the second trimester of pregnancy but who asked not to be named for fear of being victimised, said she has been buying drugs from a private pharmacy to control her preeclampsia (high blood pressure) condition throughout the week of her admission at the 170-bed capacity facility.
Many women have lost lives before or during birth due to preeclampsia, and the latest high-profile victim was Iganga Woman Member of Parliament Grace Hailat Kaudha, 31, who died early this month at Kawempe Hospital.

The female patient who on Monday spoke to us on condition of anonymity accused some of the nurses at Kawempe of lifting drugs home after work, some of which they sell to unsuspecting patients.
The hospital spokesperson, Ms Sarah Ndibalekera, however, said they had no evidence to support the allegation but any of their staff caught stealing medicine would be reprimanded.

“Whenever the National Medical Stores delivers [drugs and supplies], we give what is available to the mothers, but at times we run out of these items due to high patients’ numbers,” she said. The stock-outs are not new. Senior doctors said Mulago hospital has over the past nine months never had supplies from NMS lasting more than three weeks.

The two months intermittent deliveries prompted senior staff of Mulago’s Obstetrics and Gynaecology directorate to read the riot act to Dr Byarugaba.
Our investigations show that 19 of the obstetricians and gynaecologists met at Kawempe Hospital on May 25 and resolved, among other things, that “due to the ongoing recurrent and long-standing lack of sundries required in emergency care, for example, appropriate sutures, spinal needles, cannulas, oxygen, drugs such as ephedrine et cetera, [we] are not able to offer standard care to patients”.

“The erratic supply of emergency drugs and sundries and poor working conditions continue to put the lives of the patients and the health workers in danger,” they wrote in a letter to Dr Byarugaba and copied to, among others, State House and Health ministry.
They added: “The senior staff advises that the patients buy the required items as per need before being attended to. We request the hospital’s top management to communicate this to the public.”
The hospital chief executive spurned the request.

In a statement issued yesterday, Mulago hospital spokesman Enock Kusasira refuted provision of services there had fallen apart.
“All our theatres are working …the public is hereby advised to disregard the baseless rumours and continue to seek healthcare from the hospital as Mulago remains committed to her sacred mandate of guaranteeing hope to life at all times,” he noted.
This claim flies in the face of specific demands by senior staff at Kawempe that patients unable to buy supplies “are encouraged to seek care from other health facilities which are well equipped to attend their emergency situations”.

NMS on Monday delivered some drugs and supplies to both of Mulago’s satellite hospitals.
Spokesman Dan Kimosho said they need Shs50b to buy adequate quantity of reagents, but they only get Shs5b. NMS officials have had a public spat with Finance counterparts over the diversion of a PTA bank loan, a substantial part of which was meant for drug procurement.

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