Private hospitals turn away pneumonic patients

As the number of confirmed cases of the coronavirus continues to rise, private hospitals and health facilities are facing allegations of turning away patients with breathing complications.
The Ministry of Health has designated Mulago, Naguru, Kiruddu, Entebbe and 14 other regional referral hospitals as coronavirus disease (Covid-19) admission and treatment centres. While Kiruddu Referral Hospital does not directly admit patients, it manages the temporary treatment centre at Mandela National Stadium, Namboole, on the outskirts of the city.
By Monday afternoon Uganda had 4,978 confirmed cases of Covid-19, putting pressure on hospital beds across the country. 
In addition, many health workers fear contracting the virus after at least 163 of them across the country tested positive. This has led to some suspected Covid-19 patients being turned away at hospitals, including Mengo, Rubaga, and other private health facilities.
Uganda has 948 active cases spread across the referral hospitals. According to the current ministry guidelines, while a number of both public and private hospitals can test for Covid-19, only government-accredited hospitals are authorised to admit and treat patients with the virus.
Mulago National Referral Hospital has 650 beds, of which 305 are currently occupied, while Namboole has 250 beds with room for more, according to Ministry data. Entebbe hospital can accommodate up to 200 patients, with current occupancy at about 120 patients, while the regional referral hospitals have capacity of between 20 and 50 beds.

Waiting to exhale
On September 3, Ms Natalie Asiimwe, took her 72-year-old father only identified as Ambrose, to Mengo hospital for treatment. 
Ms Asiimwe says her father has been battling asthma for many years and has been receiving regular treatment. 
She, however, says on the fateful day, her father developed a breathing complication and he was taken to Mengo hospital, where they were turned away and told to return after testing for Covid-19.
“We were stuck because the situation of my father was not good. We went to Mulago and no one attended to us. I had to call a doctor friend who eventually intervened and saved my father,” Ms Asiimwe recalls.
For Ms Mary Namukasa, it was one of her hardest experience. Ms Namukasa says she developed sharp pain in the chest after she was hit by rain.
Ms Namukasa says when she went for checkup at Rubaga, she was turned away. She later went to Mengo, where she was asked to first go for a Covid-19 test, then come back to the hospital with the results.
“...From Rubaga, I proceeded to Mengo hospital and there they also advised me to first go to Mulago to test before they could attend to me. No one wanted to come closer to examine me. I went back home and sent my daughter to buy for me amoxyline which I swallowed and got much better,” she said.
At the onset of Covid-19 pandemic, government hospitals such as Kawempe and others were sending away patients for fear that they would infect the health workers. 
A source working with a private health facility in Kampala, speaking on condition of anonymity, said almost all private health facilities are sending away people who have pneumonia.
“People with pneumonia are not admitted without Covid-19 certificates. Private-Not-for-Profit hospitals of Mengo and Rubaga are not taking in unconscious patients without any history as long as they don’t have a certificate for Covid-19 and they could be right,” the source said.
“So being sick in this period is dangerous. I know people who have spent nights on the road moving from one hospital to another being rejected with an ill patient in the car. I also know health workers who have rejected them. It is very serious,” the source added.
With things getting out of hand, patients who present symptoms of pneumonia and other breathing complications, are forced to lie to get healthcare.
“So now patients and caretakers are forced to lie that they have no signs of Covid-19 even if they have, so that they can get treatment then they expose the health workers. You know Covid-19 presents pneumonia-like symptoms on the chest x-ray, so the only way to tell them apart is a Covid-19 test,” the source said.

 Hospitals respond 
Private hospitals have, however, denied the claims, saying while they cannot dismiss the allegations, where they might have happened, it could have been the acts of individual staff, not the hospital policies.
Dr Andrew Sekitoleko, the executive director of Rubaga hospital, said this should have been anomaly. 
He said the hospital receives all patients irrespective of whether they have Covid-19 or not and where they have suspicion, they test from within.
“I can tell you that was an anomaly because we receive all patients. We even test them from here and have an isolation centre. If it happened, then that staff acted as an individual, but that is not the policy of the hospital,” he said.
“We have a fully equipped isolation facility here and we always work closely with the Ministry of Health so that was an unfortunate situation which we shall look into,” he added.
Mengo hospital management was equally dismissive of the report that the hospital is sending away suspects  of Covid-19. 
Mr Denis Muhumuza, the Mengo hospital public relations officer said the hospital admits all kinds of patients and doesn’t discriminate based on suspicion of being Covid-19 positive.
“As far as I am concerned, Mengo hospital does not send away [Covid-19 patients] and has not sent away any patient. We admit all patients and treat them here. The only patients we refer are those we cannot treat from here and that is through an organised referral system,” he said.
Dr Denis Kimalyo, the executive director of Uganda National Association of Private Hospitals, said while it may not be correct to send away patients, the private health facilities have had a big challenge on how to manage the Covid-19 cases. 
From the onset, government decided that all the Covid-19 patients would be managed at government regional and national referral hospitals.
“We have really had a big challenge as far as managing patients in the Covid-19 pandemic. When a patient comes, sometimes we take history, we ask for signs of epidemiological signs and history of Covid-19 and you really realise that the person is a likely case and the chances are he is or could really be having the disease. Our hands really get tied in situations where we cannot perform the test yet we need to take measures,” Dr Kimalyo said.
He said while the ministry had directed that private facilities set up isolation centres, resources have been tight and that the stigma that comes with Covid-19 would send away other patients from whom the private facilities generate all the revenues.
“I think the ministry’s communication was that have some isolation facilities within your medical facility so that you manage some cases while isolated, but this has not been possible in many cases and secondly it is causing stigma because our revenues are entirely from patients and you know that when there is a Covid-19 case in facilities, other patients run away,” he said.
He, however, said the situation at some of the private facilities that send away suspected Covid-19 patients is unfortunate and that as a leader of the association, he will dig deep to understand the motivation behind their actions.
“What they did is not right and I think these are hospitals that are big enough to have isolation facilities within their premises. I haven’t heard about that but I need to go to the ground and find out what happened,” he said.
“However, it has been a big challenge to the private hospitals and even the meetings we have been having, it was a big issue and we are trying to meet with the government to see how we can together manage this,” he added.
Dr Kimalyo asked the private facilities to refer suspected cases immediately to government set facilities for proper management.
“The government position is that have some isolation facilities to manage such cases as you consult the government. However, what we know is that some of these private health facilities are not big enough to run isolation facilities and in such cases, we ask them to refer the patients immediately as you know referral is also a way of managing such cases in medical practice. We ask that if you have such suspect, alert the government immediately,” he said.

Health ministry response
Ministry of Health has also called the allegations against Mengo and Rubaga hospitals  “untrue”.

Mr Emmanuel Ainebyoona, the Ministry of Health spokesperson, told Daily Monitor that the mentioned hospitals have on a number of cases detected Covid-19 cases at the respective hospitals and referred them to Mulago National Referral Hospital.
“These are lies because the hospitals you are talking about have even had cases referred to Mulago. Rubaga, Mengo and Nsambya have in the past detected cases and referred them to Mulaga because we issued clear guidelines for handling Covid-19 cases and they have been following. So as a ministry we are not aware of them turning away patients,” Mr Ainebyoona said.