The challenge of getting treatment in a public health facility is extreme. Poor treatment has marked one of the gravest governmental failures of modern times. A fortnight ago, we reported about the horror at Kawempe national referral hospital. Built in 2014 at about Shs 42.9 billion and officially opened to the public in 2016, Kawempe hospital boasts top-notch equipment and services, which include; quality health care in Obstetrics and Gynecology, Pediatrics, Adolescent health, HIV/Aids care, Research, and Medical Trainings.
But that quality has diminished over time and corruption is rife six years after completion, according to multiple interviews with patients there. Kawempe hospital is heavily congested yet it was built to decongest Mulago, to free up the national referral hospital to treat more serious ailments like cancer.
On arrival at the hospital, the unmissable sight is the swarms of frustrated patients and expectant mothers sitting or sleeping under the stairs or on the floor in the antenatal area. In the antenatal section, about 100 pregnant women wait to see gynecologists. The hospital is overwhelmed by the number of expectant mothers. Dozens of new mothers and pregnant women sleep on the floor.
Fast forward to last week, The Observer toured Mulago hospital to understand the challenges patients go through to get treatment. Built on Mulago hill, north of Kampala capital city, and west of the Makerere University College of Health Sciences, the hospital is approximately five kilometers (three miles) by road, north-east of Kampala’s central business district.
Not all services are free of charge. Blood transfusion, CT, and X-ray scans are offered at a cost. No one accesses in-patient wards without security clearance. Security guards man all entrances and exits. Our reporters were denied access to the men’s ward on the new Mulago building, causality, and emergency wards. Despite elaborate efforts to cover up its rot, cancer patients resting on verandas and under trees tell sad personal stories about endemic corruption at the hospital.
UGANDA CANCER INSTITUTE
Established in 1965, Uganda Cancer Institute (UCI) is located within Mulago hospital premises. It is located adjacent to ‘Mwana Mugimu Nutrition Unit and Tuberculosis ward. It offers a full spectrum of cancer management from prevention to screening and risk reduction, to caring for newly diagnosed patients, and offering specialized care for patients with advanced cancer.
The Institute offers; chemotherapy, childhood cancer treatment, adult cancer treatment, cancer screening, cancer surgery, radiotherapy, palliative care, imaging, and cancer information. The UCI diagnoses over 30,000 new cases of cancer in the country every year.
The most common cancers in Uganda include; cancer of the breast, cancer of the cervix, kaposis sarcoma, cancer of the prostate, cancer of the ovary, cancer of the liver, leukemia, cancer of the colon, burkitts lymphoma, and others.
An on-the-ground inspection of the premises revealed a lot. There were dozens of cancer patients and caregivers sleeping on verandas and under trees at the national referral hospital. The verandas have become the patients’ second homes. Their mattresses, clothes, saucepans, and sundry are littered everywhere.
Patients and caregivers speak
Interviewed for this story, patients claimed there are no beds. The few available are reserved for emergency cases.
“I have been here for two months. I am suffering from lung cancer but I don’t see beds for cancer patients,” a man from the western district of Rukungiri said, adding, “You can speak to the doctors and see if you can get a bed for your patient to rest on.”
“We sleep outside, on verandas, and waiting areas at the reception because we are not admitted. We camp around as we wait for doctors. We have no relatives around Kampala and we can’t afford the hiked transport fares every week or month. At times we come and don’t see doctors despite having appointments with them,” he said.
A caregiver interviewed on the veranda of the laboratory block said she hails from Kisita village in the western district of Hoima. Her four- month baby and the patient (her mother) decided to stay at the UCI because they can’t travel every week to see a doctor for assessment.
“The patient has moved around to stretch her muscles but we sleep here as you can see. It is a pity but we are looking for life,” she said, adding, “The services are available but there is no medicine. We see the doctors on the date they tell us to report back for assessment but we buy drugs from the nearby pharmacies and drug shops, ” she said.
Another patient from Kalisizo said she had camped at UCI for the last two weeks. “I am here waiting for the doctor to take samples (flesh from a body part) from me. I booked and I was told that he will be here next week,” he said.
This writer tried to seek help for his patient from the UCI reception. “Hello, nurse. I am here to consult. I have a patient who needs to be screened for colon cancer.”
The nurse referred this writer to Makerere Assessment Center located within the hospital premises. At the assessment center, this writer was told to bring the patient and some money for an X-ray scan and CT scan.
“The doctors will analyse the results and refer the patient to UCI or other departments for treatment,” they said.
NAGURU GENERAL HOSPITAL
Located approximately seven kilometres (four miles), east of Naguru, Nakawa municipality, Naguru general hospital, also known as China-Uganda Friendship Hospital Naguru was established between 2009 and 2012.
According to the ministry of Health, the hospital was built for about US$8 million Shs(303 billion). The Chinese government designed and built the health facility as a gift to the people of Uganda. Kampala Capital City Authority (KCCA), donated the five acres of land where the hospital stands today.
The government contributed an estimated US$2 million Shs (7.5 billion) in terms of tax waivers on construction materials, landscaping, road access, and licensing fees. The facility has seven buildings; four operating rooms, a maternity ward, a pediatric unit, a teenage center, a blood bank, a radiology department, and housing for medical staff.
Information obtained from the ministry of health website shows that Naguru hospital was built to decongest Mulago national referral hospital. It is serving an estimated three million inhabitants of the Kampala Metropolitan Area.
It offers in-patient services, outpatient services, diagnostic services, specialized curative care services, prevention and rehabilitation, community outreach services, and management and support services.
Arriving at a huge gate manned by private security guards, patients and caregivers walk freely to their destinations while others are subjected to multiple checks. Some are ordered to sanitise at the tent erected barely two meters from the gate while a few walk to the small empty tank to wash their hands, only to realize it dried up a long time ago.
At the Outpatient Department (OPD), this writer saw an overwhelming number of patients waiting to be registered to see doctors. Level two, the antenatal area, is very congested. There are dozens of expectant mothers jostling for seats while others stand as they all wait to get antenatal services. Due to the huge number of patients, some sit in the corridors.
There are no free services here. Patients from all walks of life are simply given prescription letters and are directed to buy medicines from private pharmacies. Other patients, however, camp outside the theater (inside the hospital) as they waited to be attended to. According to a source, some of them had been given appointments.
The Observer, however, visited the maternity wards and saw dozens of mothers and caregivers sleeping on the floor of the hospital. The wards are full. Mothers can’t get beds to rest after delivery. The situation was the same for the two days this writer visited the hospital. A caregiver said it is only smart people who get beds for their mothers.
“You have to keep looking into the wards and ask who is about to be discharged,” she said.
“When you come here, the first thing you do is to get a bed before mothers go into labour wards. If you fail, your patient will sleep on the floor. The easiest way is to get in touch with nurses or doctors because they know who is to be discharged. When you give them some money or when you are lucky, they find you a bed at zero cost. That is the practice; look for a bed or pay something,” she said.
Another caregiver said they spent four days at the health facility.
“She [patient] was admitted on Monday, August 22, and was expected to be operated on, on Monday, August 29. We have not been given free medicine since we arrived. We buy everything including; syringes, cannula, painkillers, and other drugs. The drug shops are just behind the outpatient department. Their medicines are so pricey compared to other drug shops or pharmacies outside the facility,” she said.
On August 25, she said, there was a scuffle at the hospital that led to the loss of a newly born baby. She said the caregivers agreed to pay Shs 1 million to doctors to operate on their patient after spending a long time without being attended to.
“She was operated on and the baby was put on oxygen. The doctors later asked for the money only to find out that the caregivers didn’t have it. The scuffle ensued and the baby was removed from oxygen and died after some time,” she said, adding, “The uniqueness about Naguru is that doctors first ask for money unlike at Kawempe and other hospitals. She blamed the caregivers for committing to pay without having the money.”
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