Time bomb: The inside story of Mulago hospital’s troubles

Sunday January 20 2013

By Chris Obore

A recent surgical camp conducted by the US-based philanthropist, Prof. Michael Haglund, brought to the fore Mulago National Referral Hospital’s inadequacy to offer quality health care.
Our investigation shows that during the camp which dealt with neurosurgical operations from January 7-11, Mulago hospital failed to avail basic theatre requirements.

For instance, the national referral hospital failed to provide facilities for sterilising equipment used during surgical operations. Sterilisation services had to be outsourced from International Hospital Kampala, a private facility.

Senior theatre staff who talked to the Sunday Monitor on confidentiality terms, said the hospital operated without adequate infection control measures during operations, thus exposing patients to danger.

At Mulago, the boilers supplying steam for sterilisation were broken down. Because of outsourcing, the surgeons had to keep waiting for delayed equipment, thus unable to complete surgeries on agreed times.

Equipment without maintenance plan
Staffers said Mulago’s boilers, autoclave and other medical equipment, were nonoperational without a maintenance plan. In addition, there is no distilled water in the hospital thus affecting laboratories and wards.

There has been increasing public outcry about the quality of services offered in the facility.
In the past, the hospital has had its intensive care unit fail to operate either due to lack of oxygen or breakdown of equipment. In labour wards, babies in need of incubation services passed on due to lack of sufficient incubators. The wards are operating above capacity with patients occupying walkways at night.

Senior management at the hospital is aware of the problem. “Because of constricted budget, we are not at the level of equipment we want,” said Dr Baterana Byarugaba, the executive director of the hospital, “It is indeed very true that we don’t have modern equipment but we are in the process of acquiring.”

According to Dr Byarugaba, the surgical camp experienced setbacks largely because the obsolete equipment is still in use. For instance, the boilers which broke down during the neurosurgery camp were fixed in the hospital in 1962 and were only rehabilitated in 1990.
“We get a hitch when they breakdown. Besides, our old equipment is serving a growing number of patients,” Dr Byarugaba said.

Mulago hospital that was built with a bed capacity of 1,500, now registers 3,000 admissions. This means, the hospital has had to do away with some beds in order to accommodate patients on the floors. And on daily basis, the health facility registers between 6,000 to 7,000 outpatients, according to Dr Byarugaba.

Operating on a budget of Shs33.2 billion annually, Mulago is unable to give you the quality service you need. From the budget, Shs20 billion goes to paying salaries, Shs8.2 billion is for recurrent non-wage expenditure, including buying food for patients, power and water bills, among others.
And the remaining Shs5 billion is for capital development, which includes buying medical equipment, repairing roads within the hospital and building houses for medical workers, among others.
Apparently, to run effectively, Mulago needs thrice its current budget.

In addition to the inadequate funding, the country’s premium hospital also reels in low morale of staffers, low pay and resettling some patients who recover but have no way to return to their homes.

Due to low pay, some workers in Mulago indulged in uncouth ways to make ends meet. Some of the engineers, would, for instance, loosen sewage pipes thus spewing the waste. This was meant to enable them get money for repairs thus make some allowance.

In other extreme cases, oxygen would be deliberately disconnected from the tunnel causing an emergency. By doing this, the concerned persons would place financial requests to the hospital for repairs.

These emergencies became frequent, thus eating into the budget. However, Dr Byarugaba says “those cases are no longer there.” He said they had built an oxygen plant which has helped solve the shortages.

When this newspaper visited Mulago and talked to some doctors and nurses on duty, they said they were equally unhappy with the reputation of the hospital now. To decongest Mulago and to generally improve on health care delivery, Dr Byaruhanga said there was need to build a hospital of Mulago’s status, at least in every region.