The pain Ugandans undergo in getting specialised medicare

Kampala. Pregnant for nearly 26 weeks, Haula Namakula, 24, was rushed to Rubaga Hospital’s neonatal intensive care unit (NICU) on January 29. Her day had begun normally and the thought of giving birth never crossed her mind, after all, she had four more months to her due date. To her surprise, however, she was ushered into the labour ward and she gave birth to six premature babies--- two girls and four boys.

Premature babies are born before the 37th week as opposed to the full 40 weeks of pregnancy and often have complicated medical conditions.
But Ms Namakula’s joy of motherhood was short-lived when doctors informed her that her sextuplets died as they were being transferred to Kawempe General Hospital. Premature babies are prone to breathing difficulties and other infections which was the same case with the sextuplets.

Rubaga Hospital’s NICU that day was full to capacity and Ms Namakula was also mindful of the high bill, Rubaga being a private hospital.
“The three babies passed on at our ICU, and the others were already dead by the time they reached the hospital, “a statement by Kawempe Hospital indicated then, after a public outrage on how the two hospitals could have failed to save any of the babies.

Sources privy to the incident, however, intimated to this newspaper that the pre-term babies had been transported in an ill-equipped ambulance with no oxygen which is very essential since their lungs have not yet developed, usually making death almost inevitable.
The sextuplets add to the estimated 11,700 newborns who die annually in Uganda due to complications of prematurity with up to 75 per cent of the fatalities preventable, according to Health ministry.
With at least 108,000 babies born prematurely every year, the same ministry data indicates that prematurity is the leading cause of newborn deaths. Pre-term care is just one of the many specialised services that Ugandans struggle to access due to inadequate resources, including equipment, human resource and drugs.

Specialised services are those that support rare and complex conditions which usually involve treatment of patients with rare cancers, genetic disorders and complex medical surgical conditions. Other services in the same category, including orthopedics, neurosurgery, and cancer and heart treatment among others, have faced similar challenges.
Prof Peter Waiswa of Makerere University School of Public Health, says these are vulnerable fields which cannot be left to anyone. For instance, Prof Waiswa says, the available NICUs in both private and public hospitals are below average except those of church-founded St Francis Hospital - Nsambya and Kiwoko hospitals, which are up to good standard.

The country has only two neonatologists. They are Dr Victoria Nakibuuka currently based at Nsambya hospital and Dr Yassa Abdalla, who has since relocated to neighboring Tanzania for greener pastures. Colleges are also yet to start training neonatal nurses. The nurses who work in NICUs are either general health workers or trained on the job by visiting specialists.

But even if institutions started training experts in those fields, it would take time to attract students since the positions do not exist in the current public service structures yet private hospitals can only afford to employ a few, if any.
The private health facilities with relatively good services are almost unaffordable due to the high cost of servicing equipment, paying experts and drugs used in treatment.
“Pre-term are so delicate, the hospitals need machines to monitor, power, space, multidisciplinary experts (pediatricians, neurologists, ENT and surgeons among others) as well as the expensive medicines,” Dr Waiswa states.

High costs
The mothers, who have given birth to premature babies in private hospitals, said they had to part with between Shs7m and Shs13m. Similarly, a dose of one of the essential drugs such as surfactant prescribed to help build their underdeveloped lungs costs more than Shs1m at a retail price in most of the major pharmacies in Kampala.
Two months after the death of the sextuplets, again this newspaper reported a similar incident where 30-year-old Jane Ankunda lost her premature baby owing to failure to raise Shs35m that had accumulated at one of the private hospitals in Kampala.

The mother’s pleas to transfer the baby to a government health facility also fell on deaf ears as she had to clear the arrears. Because many of the mothers cannot afford the services in private hospitals, public health facilities are overwhelmed, which compromises quality.
At Kawempe General Hospital and Naguru Health Centre IV, an incubator is shared by three babies, which exposes them to more infections. For that reason, Atukunda, Namakula and the many other mothers in the country can only pray to God to deliver full-term babies lest they face the same conundrum or even worse. Public health facilities are also confronted with drug stock-outs, inadequate equipment, unstable power and oxygen supply.

Shortage of specialists
Currently, there are only 12 neurosurgeons to manage the more than 35 million population. As such many patients wait to flock medical camps conducted occasionally by foreign specialists who come to the country to offer free services.
Dr Joel Kiryabwire, the president of the Neurosurgical Society of Uganda (NSU), says a recent neurosurgical camp conducted at Mulago Hospital, was able to work on only 30 patients of the 100 who turned up.
Dr John Ssekabira, the president of Association of Surgeons of Uganda (ASU), said there is currently a heavy backlog of surgical cases in the country because patients have to wait longer periods before seeing the already exhausted few specialists, hence compromising the quality of outcomes.

Amputations
At Mulago National Referral Hospital’s orthopedic ward, some patients have opted for amputation because they cannot afford implants (to replace a missing joint or bone or to support a damaged bone) which are hardly if ever provided by government.
“The implants cost between Shs300,000-Shs1m but one may need more depending on how severe the injury is. Sometimes patients have no choice,” a source at the orthopedic unit who spoke on condition of anonymity said.

The source further intimated that most of the patients are charged up to Shs1m or more to have surgeries because government does not provide enough funds to cater for all the patients.
The case is no different at the hospital’s neurosurgery department where patients with damage on their nervous systems are managed, mostly affected by shortage of specialists despite handling the most technical cases given their location at a referral centre.
Both orthopedic and neurosurgery specialised services are very critical in a country where road accidents, which are the major cause of such injuries, are rampant.

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