Irene Aganyira got excited when she conceived. The 20-year-old resident of Kigorobya II village, Kigorobya subcounty in Hoima District had hoped to have her first child in May 2017. However, her trip to Kigorobya health centre IV shattered her dreams.
After being admitted, Aganyira claims that she was initially unattended to and when the nurses finally came, they asked her for a polythene roll which she did not have.
The polythene roll was to be laid on the delivery bed.
She went to the health centre in the morning, developed labour pains later in the day.
“The nurses did not attend to me. They kept reminding me that I did not come with the requirements. I tried to push (the baby) but there was no one to help me. They accused me of being “unclear in my language,” says Aganyira, a house wife who stammers when she speaks.
She was reportedly referred to Hoima regional referral hospital at about 10pm but there was no ambulance to take her to the hospital which is located about 15 kilometres from Kigorobya health centre.
As she was still pondering on the next move, the baby died.
Depressed and hurt, Aganyira retreated to her village grumbling and has threatened never to return to seek maternal care at a government health facility when she conceives again.
“I felt helpless to take on government workers. I left everything to God,” she says with a grim on her face.
Aganyira is not alone. She is among the several women who are losing their children at birth at various health facilities in Hoima District.
Access to maternal care
Some mothers shun health facilities and opt to seek the help of traditional birth attendants while others seek support from trained health personnel and herbalists at a fee.
With parents unsure about the survival of their children, they decide to produce more in order to reduce on the risk so that when some die, others survive.
Asked how the district handles complaints from mothers such as Aganyira, the Hoima District Health inspector, Fredrick Byenume, says many mothers do not register their complaints when they face challenges at health facilities.
He however promised to get in touch with her and investigate the matter with a view of taking action against workers if they are found culpable.
Some expectant mothers delay to seek antenatal care, according to Byenume while others think traditional birth attendants are a better option.
Where complications arise during or after birth, Byenume observes that health centre IVs in the district such as Kikuube and Kigorobya have secured ambulances which are used to refer expectant mothers to Hoima regional referral hospital.
“However, theatres in those health centres are not operational because we lack anesthetic officers and some equipment,” he said.
According to Byenume, the Ministry of health has promised to recruit anesthetic officers and equip the theatres to enable them function.
In a bid to alleviate the transport challenges, World Vision Uganda, an international humanitarian organisation donated an ambulance worth Shs220 million to Kikuube health centre IV while the Kigorobya County MP Mr David Karubanga donated an ambulance to his voters who seek services at Kigorobya health centre IV.
However, the benefiting health facilities lack operational funds to fuel the ambulances and recruiting a driver.
Mr Biira Nasser Kiwanuka, a coordinator of Midwestern Regional Anti-Corruption coalition (MIRAC), a Bunyoro regional anti-corruption organization said failure to budget for operational funds of ambulances has caused extortion of patients in many public health facilities.
“Our research has indicated that to use an ambulance, the client is asked to pay fuel amounting to about Shs150,000 yet that money is not receipted,” said Kiwanuka.
Faced with such constraints, Kikuube health cente IV authorities handed over the ambulance to Hoima District local government until funds are allocated to run it and a driver employed. The nearest the district will budget for such funds may be next financial year.
Much as Kigorobya and Kikuube health centre IVs have built up theatres, they remain non-operational.
While inspecting Kikuube health centre in May this year, Primary health care state Minister Dr Joyce Moriku Kaducu discovered that despite having two qualified doctors and medical equipment, the theatre is non-functional.
“The doctors are here. I’m not happy to see an unused threatre and rusting equipment. I feel sad that we are wasting resources,” she said shortly after presiding over the handover of an ambulance that was donated by world vision Uganda to Kikuube health centre IV.
Dr Kaducu who saw some of the rusty beds in the theatre tasked the district leadership to ensure it begins operating normally as soon as possible in order to save the lives of expectant mothers who struggle to get care in distant health facilities.
Before his constituency receiving an ambulance, the Buhaguzi County MP Mr Dan Muhairwe said his personal car would at times act as an ambulance.
The records indicate that Kikuube health centre helps more than 100 mothers to deliver every month. The expectant mothers who require cesarean operations are referred to Hoima regional referral hospital which is located about 30 kilometres away.
The Hoima District Health officer, Dr Joseph Ruyonga informed the minister that the theatre table got spoiled and requires repair at the medical workshop which is at Hoima regional referral hospital.
He further informed the minister that the theatre lacks a blood bank and some medical equipment which are required for the theatre to be operational. Dr Ruyonga underscored the importance of mothers delivering at gazetted health facilities in order to curb maternal mortality cases which he said are rising due to mothers opting to deliver in their homes or with the help of traditional birth attendants.
Catherine Aheebwa, 22, a wife to Herbert Munyomo, a teacher and resident of Kigorobya town council in Hoima District has twice found difficulty in delivery at Kigorobya health centre IV. Munyomo has protested the alleged mistreatment of his wife but in vain.
Aheebwa who had labour pains was admitted at Kigorobya health centre on March 13,, 2015 with a hope that she would deliver normally.
“After spending there two days, we were referred to Hoima regional referral hospital after I was told that her case was complicated and required an operation which the health centre couldn’t do,” says Munyomo.
In the absence of a functional ambulance, he hired a car to transport his wife to Hoima hospital where he anticipated better medical care.
“We reached the hospital at about 10am and she was taken in the labour suit. Without being operated, she was kept there unattended to and eventually had a still birth at about 4pm,” a visibly irritated Munyomo claims.
He believes that was a case of negligence by health officials at both Kigorobya health centre IV and at Hoima regional referral hospital.
With the pain of losing his first born baby, Munyomo decided to petition the Hoima Chief Administrative Officer (CAO) Nathan Lujumwa claiming that his pregnant wife was neglected on September 18, 2017.
In his complaint received and stamped by the Hoima district central registry on September 20, 2017, Munyomo claims that his wife reached Kigorobya health centre IV for delivery at 6.50 am on September 18 2017 but the officer on duty declined to attend to her and instead referred her to Kitana mission dispensary, a private facility of a lower status compared to a health centre IV.
Unfortunately, when Aheebwa and her helper reached Kitana mission dispensary, there was nobody to attend to them, Munyomo states in his letter copied to the Public service state minister Mr David Karubanga.
Aheebwa opted to go to Gloria health centre, another private facility where she delivered a live baby, according to the two page petition.
In view of the above background, Munyomo stated that he believes that the conduct of officers who were on maternity duty at Kigorobya health centre IV on September 18 between 6.50am to 9.37am amounts to negligence of duty.
“I hope you will see to it that the concerned public officers are administratively disciplined and successfully prosecuted so as to deter medics from being negligent in future,” Munyomo wrote to the Hoima CAO Mr Nathan Lujumwa on September 19.
Lujumwa who is about two months old in office has promised to investigate the incident up to its logical conclusion.
Between 150 to 200 expectant mothers seek antenatal care at Kigorobya health centre IV every month but 70-150 deliver at the facility every month, according to statistics at the health facility.
Due to delays in referrals, most mothers from distant rural areas such as Kyangwali Sub County which is over 80 kilometres away from Hoima regional referral hospital reach the facility in a dire state. Non-Governmental Organizations (NGOs) such as Think Humanity (TH) have been handy in providing maternal care to mothers in remote areas such as Kyangwali subcounty. TH runs a clinic that offers maternal services to refugees in Kyangwali refugee camps and surrounding communities whose nearest health facilities are over 30 kilometres away. Referral cases are sent to Hoima regional referral hospital that is over 80 kilometres away.
“Some (mothers) reach here already raptured, others already dead while other children are delivered with complications,” says a medical worker at Hoima hospital.
But even the mothers that arrive at the hospital face numerous challenges.
According to Police detectives, a newly born baby was stolen at Hoima regional referral hospital on July 10 at about 6pm.
“Investigations have revealed that Erianah, a Rwandese refugee from Kyangwali refugee camp delivered by caesarian operation under the help of medical workers at the hospital,” the Albertine regional police spokesperson Mr Julius Hakiza says.
Erianah had gone to the hospital with her husband Murumba Karara and her in-law, one Jackyline Uwineza.
In his statement at Hoima central police station, Karara says shortly after his wife delivering, a nurse on duty sent Uwineza to pick a stretcher which would be used to transport the baby and the mother from the delivery bed to another bed.
“By the time Uwineza returned, the baby was nowhere. My wife says it was picked by a woman who was working with nurses who were on duty,” Karara says in a case of theft of a baby filed at Hoima police station under reference CBR/54/10/07/2017.
The Hoima Regional referral Hospital director, Dr Peter Mukobi, said the hospital has sought for the intervention of Police to recover the baby.
“We have also increased security within and around the hospital so as to prevent such occurrences,” he said.
Five months after the incident, police have not recovered the baby.
Burden at Hoima hospital
Hoima regional referral hospital receives many maternal referrals cases in Bunyoro Sub region which would have been handled by health centre IVs if their theatres would be operational.
During the 2015/2016 financial year, 4,113 mothers delivered normally while 2, 471 delivered by caesarian at Hoima hospital, according to records at the health facility.
In the 2016/2017 financial year, 5,033 mothers delivered normally at the hospital while 2,329 delivered by caesarian operation.
The Hoima regional referral hospital’s Principal Administrator Hajji Ereaser Mugisa acknowledges that the hospital offers comprehensive maternal and child health services but there are some constraints in offering quality health care.
The hospital’s maternal unit is understaffed but overwhelmed by the high turn up of mothers. The unit has one consultant out of the three that are provided for in the hospital staff structure.
“There are 12 midwives out of the 20 that are supposed to be in the unit in the hospital structure,” Mugisa adds.
The unit has two medical officers and 19 enrolled midwives, out of the 20 that are required.
Mugisa says at peak time, the hospital conducts between 15 to 25 deliveries every 24 hours.
The hospital’s ambulance has outlived its usefulness which affects referrals to Mulago national referral hospital which is in Kampala, over 200 kilometres away from Hoima.
Hoima regional referral hospital at times runs out of blood and other medical essentials either due to delay in receiving supplies from National Medical stores or due to high turn up of patients, the supplies are used up shortly after being stocked.
The hospital lacks a blood bank and relies on Nakasero blood bank in Kampala for screened blood.
“Because we lack a regional blood bank to process the blood, we take blood to Nakasero (blood bank) which is over 200 kilometres away which translates into time lag. At times we lose some mothers,” Mugisa says.
To improve staffing levels, government has increased the Hoima regional referral hospital wage structure from Shs2.8 billion in the 2016/2017 financial year to Shs4.1 billion during the 2017/2018 financial year, Mugisa says.
“This increment has helped us to improve our staff enrolment from around 50% to 75%,” he adds.
In order to improve delivery facilities, government of Uganda with support from the Japanese Government has constructed a new theatre at the hospital and plans are underway to rehabilitate the old theatre.
Hoima hospital’s consultants are currently undertaking a study to establish why theatres at health centre IVs in Bunyoro region are non-functional which leads to several mothers being referred to Hoima hospital.
Tired of the bureaucracy in government-aided health facilities, some patients have opted to risk their lives with traditional birth attendants.
Mr Fred Tumwesigye a resident of Kyamuseesa village, Mpasaana Sub County in Kakumiro District claims that his sister, Ms Agnes Kyampiire, 19 died in in June in the hands of a traditional birth attendant much as the family had initially wanted to transport her to Hoima hospital for better attention.
The deceased developed labour pains and was secretly taken to the attendant’s home.
After spending nearly seven days there, Kyampiire’s health reportedly deteriorated and she died while giving birth.
“Hoima District authorities are sensitizing mothers to seek care from trained physicians in health facilities instead of using self-medication or seeking support from traditional birth attendants and herbalists,” says Dr Joseph Ruyonga, the district health officer.
Mr James Mulindambura, the Hoima District secretary for health and education says more staff will be recruited and more advocacy will be done for increased budget for the health sector if the district is to improve on maternal health.
According to the 2014 national housing and population census report, the infant mortality rate was estimated at 53 deaths per 1000 live births in 2014 showing an improvement from 87 deaths per 1000 live births in 2002.
Under-five mortality rate was estimated at 80 deaths per 1,000 live births in 2014, an improvement from 156 deaths per 1,000 in 2002.
In 2000, Uganda joined the rest of the world in setting the Millennium Development Goals (MDGs) that were supposed to be achieved by 2015.
Target 4.A was to reduce by two thirds, between 1990 and 2015, the under-five Mortality rate.
Under Goal 5, countries targeted to reduce by three quarters, between 1990 and 2015, the maternal mortality ratio.
According to the MDGs report for Uganda which was published by UN in 2015, Uganda’s maternal mortality ratio fell from 506 per 100,000 live births in 1995 to 438 in 2011.
The World Health Organization (WHO) and other UN agencies predicted Uganda’s maternal mortality in 2013, at 360 per 100,000 births.
The report said although the overall fall in maternal mortality has fallen short of the MDG target, Uganda made impressive gains in reducing maternal deaths occurring within health facilities.
Government has prioritized access to skilled birth attendants, increasing health worker recruitment to detect and manage complications during pregnancy.
“This has contributed to a large fall in cases of life-threatening complications such as antepartum hemorrhage” the report read in part.
The report applauded the Government’s Child Survival Strategy which aims for universal access to a number of high-impact interventions including micronutrient supplementation, malaria prevention and treatment, immunisation, prevention of mother to-child transmission of HIV, and improved water and sanitation.
Training programmes for birth attendants and other health workers launched by the Ministry of Health have also helped to raise new-born care standards and the diagnosis and management of common childhood illnesses, the report said.