Sunday January 27 2013

Kawolo: A hospital on its death bed

Kawolo: A hospital on its death bed

Kawolo Hospital’s Antenatal ward. Nurses say they are resigned to the hospital’s fate.  

By Ivan Okuda

The first thing that welcomes you to Kawolo Hospital is a gigantic signpost showing visiting hours. It bears an image of a smart doctor, clad in a green lab coat with a stethoscope. His infectious smile, let alone its broadness, gives the impression that all is well, in what some people call “Mukono’s grave.”

A heartbeat away from this signpost is a long ditch with stagnant water and floating algae. Mosquitoes are ‘happily’ breeding. From the outset, the buildings speak volumes about their inside. Plants grow on the iron sheets, which bear holes.

A few people are scattered all over the fairly neat compound. Palms are stuck on the cheeks for some while others do light laundry. The mood is generally dull and mildly tense.

Officers not on duty
At the entrance to the administration block is a notice from the senior sadiographer dated 11 December 2012 to all Clinicians and Medical staff. It reads, “This is to inform you that the X-ray machine is out of service due to a mechanical problem. However, the ultra-sound machine is working.”

At this point, I get more energised to have, “a feel, see, touch and smell,” experience of Kawolo Hospital, as I explain my mission to the receptionist. It is 9.30a.m. but most offices are still locked. The ward-in -charges and senior hospital officials have not yet reported for duty. Some report later around mid-day. “Well, the problems of Kawolo could be more than what meets the eye,” I whisper to myself as I head to the men’s ward.

The elderly, youthful, adults and teenagers are all crowded here. The challenge of space is obvious from the sight of some patients lying on old mats below tied beds. Apparently, the ward is designed for 24 patients but accommodates twice the number.

There are a few idle beds. However, they are not just idle but broken beyond repair though some are supported with bricks. One feature cuts across the bedding structure here; from the mattresses without covers (mackintoshes) to torn nets and blankets, everything old and mal-functional seems to be condemned to this ward. Otherwise what explains the broken, rusted and dirty lockers beside every bed? Even the broom with which the cleaner is sweeping is old and shabby. It is just that she uses her palm to shield her sharp nose from the dust raised from the potholed floor. But it is clear even if she had gloves or gumboots, they would be either too old or torn or both.

Nurses are helpless
I force myself to imagine the nurse’s room is different and check in there. A broken tap with a collapsing sink and cobwebs welcome me. “We have not had water here for over a month now,” an elderly nurse emotionally says, begging to leave as she is exhausted, thanks to the night duty. She sympathetically holds a syringe and stares at the steriliser.

“This steriliser is too old, at times it jams but we have no option,” she says, hitting it with her palm as if begging it to resume work.

“In Kawolo we improvise most things, otherwise you can’t manage,” she says. She speaks of the problems in this particular ward with impressively thorough knowledge. The patients, she says, are mixed up in this one ward regardless of their ailment.

Those with malaria, tuberculosis, HIV/Aids, asthma, high blood pressure, and any other disease are all here. Yes, even accident victims are rushed here. But at least not Ebola. Actually the hospital has never admitted an Ebola case but ones imagination can only stretch itself far and wide. I take time to interact with one of them, who stubbornly refuses to reveal his name.

Angry patients
One patient, amid a flurry of coughs, told me he just came to the hospital to die in the doctors’ hands. He harangued Government for buying tear gas, jets and cars, yet he was suffering in hospital. He rounded it off saying the hospital was built by Dr Apollo Milton Obote, but that the current regime had left it to rot away.

He hitting his bare and bony chest with his fist as he spoke. When the conversation takes on a tense and sensitive political twist, I signal the nurse so we can move on. “When we have accident victims and there is no free bed, we treat them from the floor,” her colleague, visibly a trainee nurse, speaks without traces of morale on her face.

Their eyes grow almost teary as they speak in chorus, “We are not safe here. We attend to patients with all sorts of diseases but without masks, at times gloves are not there. Look at that cleaner, that dust can infect her with tuberculosis!”

From their resilient tone and facial language, they appear ready for anything and everything these risks pose to their health but what remains a bother is lack of equipment. “We have sacrificed for the sake of our profession but what can we do when drugs, water, electricity and other supplies are not steady?

“There are times when we have massive accidents on that Jinja-Kampala Road. People pour in the ward and deny us the space to operate,” this nurse narrates, insisting to speak on condition of anonymity as she hints on poor facilitation of the security guards as the root cause of this problem.

“Even the visiting hours are not respected. At times, doctors have to plead with the patients’ attendants to leave but they are strong-headed,” she adds sadly.

As our conversation and walk around the ward continues, the sound of patients coughing, others screaming in pain is overwhelming. Meanwhile, some attendants are cleaning their patients with stained, dump towels.

“The ward has no screens so privacy of the patient is a luxury here. Even that wire mesh on the windows was brought by some bazungu otherwise it used to be open space,” she narrates, advising me to tread carefully as chances of catching an infectious disease from the TB ward are high.

Right to the pediatric ward
Stretching the eye from the corridor, the children’s ward appears well spaced and more organised. And why not? I mean, it has the leaders of tomorrow, pretty tender and innocent little souls. But alas; the first bed that meets my eye has four thin and dehydrated children of age range two to five years. Their mattress is torn without a cover and is supported by wood. These little patients are lined up horizontally. The first one is on life-support, the second is receiving blood and the other two are on water drip.

Their bodies so pale and worn out that one can count the ribs, speak of pain and misery their hoarse voices cannot utter. From the children’s wincing and gnashing of teeth, it is clear they are appealing to Jesus Christ for space. Just a little space to comfortably receive this life changing treatment. Yet their sorrowful mothers are as helpless as the nurses who are doing their work with a touch of passion.

Broken, rusted, and dirty lockers that house bottles of juice and porridge. Scattered torn nets. Taps without running water but sinks with cob-webs. Old and naked mattresses drained with urine and fluids. Everything is the same with the ward where their fathers are in equal or even worse pain.

The only difference could be the frequency and volume of their screaming and yelling. True, the pain of the injection pricking their buttocks is behind these wild screams. But even more is the unique pain these little ones emit from their hearts. Theirs is the passionate cry over a ward with despair written on all its pale and stained walls. This pain so moving and touching is about the broken taps without water which compel their fatigued mothers to struggle for water from one jerrycan. This is on top of using buckets and containers to answer nature’s call, as the toilets are broken down.

Every deep breath that follows a long yell is of the worry of catching more diseases, thanks to mixing with their peers suffering from all sorts of diseases.

But their misery could be the artful work of fate. The situation is no different from their mothers’ (women’s) ward. Here, a room labeled “kitchen” has three patients silently struggling to fit in the limited space as nurses hustle their way through to reach their table. The cycle of life in the four wards, save the fair maternity ward simply gives the true portrait of Kawolo Hospital.

At this point, I ask for directions to the mortuary but all the three responses I get run along the line, “The mortuary is not working, there’s no one there. Get an askari to take you there.” I am later informed the fridge is broken down. This forces the hospital to give relatives of the deceased a four-day ultimatum to pick their bodies, lest they are buried in the Town Council burial grounds.

“The Ministry of Health asked Kawolo Hospital to facilitate its technicians to come and work on the mortuary’s fridge. But it’s like a father asking his needy child for money,” a senior official, said.

What hospital authorities say
From the broad smile with which he ushers me to his humble office to the smartness he exudes, Haruna Wamala, the hospital administrator comes off as a contented corporate running an efficient world class facility. But not until he speaks of problem Kawolo.

He speaks as though he has read the diaries of the staff I have encountered at the wards.“This hospital doesn’t receive funds for capital development. We only get the conditional grant from government,” he says, explaining why they can not undertake repair works.

We go for a round visit of the entire hospital and at the operating theatre is a new and standard operating table. It only came as a donation from the United Kingdom in April 2012. “You can’t believe we had been stressed with an old fashioned operating table of 1968!” he says, prompting me to imagine an inelastic and outdated operating table of 44 years! The hospital has one functional ambulance for all its emergencies, including accidents and referrals to Mulago National Referral Hospital. This fuel guzzler is allocated a periodical fuel vote of three months (one quarter) yet on bad days, it consumes fuel worth Shs70,000 to Shs140,000.

“Remember it can only carry one patient and there are times it has to take four patients to Kampala,” he folds his arms, leans against the chair as I picture his situation. Good enough though, the Mukono police ambulance once in a while comes in to fill the gap. “We have a serious problem of load shedding; Umeme cut us off and yet the hospital has to run!” he says.

As if that’s not enough, by the time of publishing this story, the hospital is still negotiating with National Water and Sewerage Corporation to reconnect its water over a Shs30m debt. The standby generator runs on over 40 litres of fuel a day yet the funds for fuel remain static.

He confirms the X-ray machine is out of service and almost breaks down at this point. “That has worsened our problem. We now have to refer more cases to Mulago for x-rays because doctors can’t prescribe treatment for what they can’t diagnose,” he shares.

Worse still, the hospital, given its location on the accident prone Jinja-Kampala highway receives over 5 accident victims daily. “Even when an accident victim is in critical condition, we can only give first aid and then refer to Mulago because the doctors cannot do any X-rays now,” he adds.

Whereas the standard doctor-patient ratio is 1:50, at Kawolo Hospital, there are only five doctors. Of these, one is pursuing further studies meaning he can only work over the weekend, two are on contract. The fourth is the medical superintendent, “who is over-burdened with administrative duties.” Practically, this means that the hospital, out of its recommended 11 doctors has one full time doctor working on a doctor-patient ratio of 1:300.

Indeed, from all the wards we visit down to the laboratory with over 200 patients desperately fidgeting for blood and other tests, the cry from all medical workers comes off like a poem they have trained to recite over the years, “Heavy workload, lack of enough equipment and unsteady water and electricity supply.”

Some of the nurses, sickly and old though they are, at times have to double as counselors. Out of the 116 the hospital requires, only 95 are in service. “We only smile when the medical students come for internship. The workload reduces a bit,” the hospital administrator says, patting one of the volunteers from Red Cross Society. The problems of this hospital need a book’s space to enumerate and it is only safe to venture to the brighter side.

According to hospital officials, Kawolo faces budget cuts from its annual Shs154m allocated in four quarters of Shs38m. The Ministry of Health is threatening to reduce this to Shs34m) following withdrawal of donor funding to the government in the excess of Shs300b over colossal corruption.

Its private wards, the would-have- been sources of extra funds, “are no different from the public wards so they cannot generate much money,” Wamala asserts.The three security guards who work in shifts are mandated to man 23.4 acres, near a sugarcane plantation. This has rendered the security so loose that unscrupulous people easily sneak in and steal the already constrained beds and mattresses.

The staff continue to languish in over-crowded quarters with broken sewage systems. Day in day out, the hospital wishes its water will be reconnected, the supply of drugs and other basic supplies stabilises and above all, the Ministry of Health policy makers make good of their promises. However, despite all these and more challenges, the hospital stands tall and remains resilient. Its medical workers talk and do their work with passion and extra-ordinary commitment.

This perhaps explains why some charity organisations like Sustain, Water For All, Save The Mothers and Ganda Foundation once in a while donate basic hospital needs. These donations though, are mainly geared towards specific wards that match their scope of work. For instance, Save The Mothers donated a water purifier, solar system and water tanks while Barclays Bank donated beddings, all to the maternity ward.

“It’s no surprise that the child and mortality rates have tremendously reduced,” as Mr. Wamala happily notes. On the other hand, Sustain has devoted considerable efforts to uplifting the HIV/AIDS clinic which is changing lives of many through specialized Anti-Retroviral Treatment and capacity building training for medical workers.

But the question that lingers in the hospital remains, When will Kawolo Hospital get a facelift? Who shall save the hospital from its coma once and for all?