Monday May 6 2013

Naguru hospital: The sad story of a new health facility

Right, a long queue of patients.

Right, a long queue of patients. The queues usually start early in the morning and one can stand for hours before seeing a doctor. The hospital say they receive about 500 out-patients every day. Photo by Rachel Mabala 

By FARAHANI MUKISA

It is a beautiful Wednesday morning. At 5.30am, I embark on a mission to spend a few hours at the newly constructed China-Uganda Friendship referral Hospital at Naguru.
I intend to find out what is happening at the hospital that was set up with the aim of decongesting Mulago National Referral Hospital, despite the fact that it is now facing numerous problems, from cleaners demonstrating for their two months’ salary arrears, to patients going without essential medication.

At exactly 6am, patients are already entering the hospital gates, one by one. Moments later an ambulance brings a woman in labour and she is rushed to the maternal ward, probably in her final stages of labour.

By around 6:30am, some nurses who worked on the night shift have started leaving for home. Two nurses come in 15 minutes later. I find out that they are in charge of the children’s ward.
At exactly 7am, patients are queuing in the waiting room for registration. Each is holding a 48-paged book. I am curious about why they have these books and I soon find out.

In the emergency room, one woman keeps moving from door to door slowly. When asked why she is doing that, she says she is looking for any doctor or nurse for assistance, as she had come early in the morning for treatment but had been in the line for four hours. She had no hope of being attended to.

She finds a nurse and asks her if she can help, because she is feeling very weak. But because she has no book, the nurse asks her to buy one first, then she can help.
The nurse tells her that the book costs Shs500 and that she can buy one “from a lady sitting by the security room at the gate.” Unfortunately, the woman does not have even a single coin. I dig into my pockets and get a Shs500 coin which I give to her.

The registration books
When I inquire about these books, the nurse tells me that everyone must have a book if he or she wants to be registered to see a medical officer at the hospital. It seems the hospital does not have the stationery to register the patients. Someone somewhere is making brisk business.

Back in the registration room, I single out a woman, Ms Angela Nabukera, who is carrying her little two-year-old daughter. She tells me that her daughter is critically ill, suffering from s Typhoid. Nabukera tells me that she has been referred here from Matenge General Medical Clinic in Kawempe.

“She has been put on two water bottle drips and a quinine drip, but there has been no change in her condition at all,” she tells me. When I check the time, it is 8am and the queue had already formed a snake-like shape up to outside the hospital entrance door and the room is filled to capacity. There is a lot of noise from crying children.

Unfortunately for Nabukera, there is no sign that her daughter will be helped soon.

Finding a shortcut
Later, however, she asks a cleaner whether there is any way she can jump the queue and get her girl treated quickly. And that is when she is taken to an emergency ward, where she is asked to pay Shs25,000 for quick intervention.

But even after paying for the services, Nabukera is given Amoxylin and Panadol and told to buy the other drugs from the pharmacies outside. When asked about the trend, Dr Edward Nadumba, the hospital director states no person should pay for the services at the hospital.

In fact, all over the hospital walls are posters indicating the same information, but according to patients who talked to this reporter, the nurses solicit money from them. “If you are in hurry and you do not want to spend much time lining up, you talk to a nurse and you are given quick service at a cost of between Shs10,000 to Shs30,000,” said Ms Silvia Nanjego who had brought her six month old son for immunisation.

After spending at least six hours at the registration room with the queue hardly moving, as there is only one person attending to the patients instead of the supposed three, I decide to go check out the maternity ward on the second floor.

Mothers waiting for examinations are sitting all over the floor. Others who have already delivered are sleeping on the improvised mattresses. The lack of sufficient beds, according to Dr Nadumba, is because the hospital is not yet fully equipped and lacks capacity to accommodate all mothers with chairs and beds. He says, they have developed a policy as a hospital, after realising that patients’ numbers were overwhelming the resources they have.

“We decided that, a patient should not spend more than three days in the ward,” he says. “Unless the condition is not improving and he or she needs more time to be attended to,” he adds.

It’s now lunch time, and some nurses are sharing lunch with families of those who had come to take care of their patients in the ward. I ask a nurse, who prefers to be called Sister Margaret, whether it is not shameful for her to share food with patients.

She freely tells me that, “The patients also know our situation. Have you heard anyone shouting at any of us for the services? We explained to them about the state of our work and they know we have not received salary for three months.”

At the time, Dr Nadumba was optimistic that the money would be paid by April. So were other senior officers at the hospital. “We have an assurance that the medics will be paid because the Finance Ministry already disbursed some Shs862.3m for salaries of the medics,” said Ms Winnie Serwanja, the principal administrator at the hospital. But even up-to-date, nurses say they have not been paid.

A vow to work
It is clear with most of the medics at the hospital, that it is the commitment they have and medical vows they took, that keep them coming back every day, otherwise they would have quit working at the hospital.

While talking to some of them, I learn that about 10 nurses and a doctor are no longer reporting to work because it is alleged that they have failed to get transport to bring them to the hospital. When I contact one of the nurses who has stopped reporting for duty, she says she had borrowed beyond what she could pay back.

“It’s better I stay home and resume work after they have paid,” she says. “I have no transport to work and I am tired of walking from Nsambya to Naguru every day,” the nurse who is supposed to be working with the emergency ward says.

I leave the hospital and go back at at 10pm in the night. What I find is a deserted facility. In that one hour visit, I manage to see five nurses on duty, two nurses attending to expecting mothers in the maternal ward, other nurses in the paediatric ward, and one nurse in the emergency ward. The rest of the departments have no attendants.

I leave the place, my heart bleeding for the patients who seek free services and instead find this at this facility.

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About Naguru Hospital

It is nearly a year since China-Uganda Friendship referral Hospital at Naguru was opened. The hospital was built by the China government as a donation to the people of Uganda.
According to Health Ministry permanent secretary, Dr Asuman Lukwago, the main aim for the upgrading the hospital was to decongest Mulago hospital.

But in what could explain the saying that, not all that glitters is gold, the beautifully light-yellow furnished facility is already facing numerous problems. The hospital which was constructed at a cost of $8m (about Shs20.8b), and a contribution of $2.5m (about Shs6.5b) from the government of Uganda, was officially opened on January 6, 2012 and started operations in June.

According to the hospital authorities, the facility is already sinking into trouble. The nurses are silently striking because they have not been paid for months. The patient turn up overwhelms the staff numbers and of recent, two administration computers have been stolen.
“We have 100 beds and yet we receive a daily turn up of at least 500 out-patients,” Dr Nadumba says. “We have only two specialised doctors, five medical officers, eight clinical officers, and the rest are nurses.”

Dr Nadumba explains that, ideally, for the hospital to fully meet its intended obligations, it requires over 500 beds. Each medical department needs a specialist, a clinical officer and five support staff.

The hospital which sits on two acres of land which was initially for the Naguru Teenage Centre has no functioning Intensive Care Unit, and it has a few incubators. The hospital director says, the hospital currently has no basics of a referral hospital. For a hospital to be called a referral, he said, it has to have a training school, departmental specialists and consultants not medical officers, and a functioning emergency ward, which is not the case with. He said, the facility is currently fit for general hospital stature.

Dr Asuman Lukwago, the permanent secretary in the Ministry of Health, says the hospital is under the management of the Ministry of Health, although it receives funds directly from the Ministry of Finance.

He noted that the facility was understaffed because it was still under expansion, adding that the delay in salary payments was not isolated. “The government was still migrating names into the integrated personnel and payroll system and several hospitals have been affected,” he said.
Naguru hospital has an average of 230 workers and receives an annual wage bill of Shs1b.

fmukisa@ug.nationmedia.com

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