Condemned health centre beats the odds in Pakwach

A mound of rubble lies between what once was Pakwach Health Centre IV’s maternity unit and the morgue. Only six months ago, the mound of rubble was where patients who wanted to use the toilet ended up.

Besides the rubble, a stone’s throw away from River Nile, is an abandoned house that played host to the generator.

Look anywhere and what you see is what once was. This is the distressing story of Pakwach Health Centre IV.

As Mr Robert Steen Omito, the Pakwach District chairperson says, the health centre operates out of dilapidated and condemned structures.

The National Environmental Management Authority (Nema) has blocked the medical facility from constructing any new buildings in the area. Reason? Because of its proximity to the banks of the Nile River.

“They told us that most buildings in the health centre lie within the 100-meter buffer, which should mandatorily be reserved around every river,” Mr Omito tells Sunday Monitor, adding: “For this reason, Nema condemned further construction of any new structure within the facility.”

This has been a long time coming. Four years before Pakwach acquired a district status in 2017, the health centre got the red flag from Nema.

“There was also a big problem of galleys caused by the roadworks and it has caused a lot of soil erosion around the premises of the health facility,” Mr Omito says, adding he has been told this could trigger “a landslide.”

Twenty-eight hectares were identified by the district to relocate the health centre, but letters to the Health ministry have gone unanswered. So a part of the health centre maintains a rather ghostly structure by the river’s banks. The abandoned maternity unit boasts of visibly cracked walls and broken windows.

In the theatre behind the abandoned building, a government ambulance takes turns delivering pregnant mothers booked for caesarean section (delivery) procedure.

Ms Cissy Canpara Opoya, the officer-in-charge of the maternity ward, says it was relocated to a new place at Kapita Village in Pakwach Town Council in 2019.

This is approximately three kilometres away from the health centre. Fears that the condemned unit could cave in informed the relocation.

Punching above its weight

Whereas the Health ministry supported the health centre to construct a new maternity home, Ms Opoya says carrying the mothers from the maternity unit to the health centre poses a challenge.

“It is a tough job to do since the facilities are situated apart and the distance complicates the situation,” she says, adding: “The labour suit itself is supposed to have those delivery beds, but we have only a two-bed capacity.”

While the beds are only two, they deal with—Ms Opoya adds—“over eight deliveries” each day.

She adds: “The new maternity unit does not have an operation theatre attached to it, so the capacity of the maternity is not enough as compared to the patient flow. The beds are not enough and as a result, others sleep on the floor.”

This is remarkable not least because the health centre serves a huge population. It stretches from the DR Congo border to districts such as Nwoya, Buliisa, Madi-Okollo, and Nebbi.

Besides the high number of deliveries conducted at the new unit, Ms Opoya says they are prompted to conduct other services such as EPI (Expanded Programme on Immunisation) and MCH (Maternal and Child Health) care services. All this is done in tricky circumstances, including under tents.

“It is only those that need examination that is when we bring them inside for other examinations and investigations,” she reveals.

Asked why the maternity unit has to operate outside the facility, Dr John Bosco Oryema—the officer-in-charge of the facility—says the dilapidation of the unit forced them to erect a new structure.

“We feared that in any case, these structures would fall on the mothers and would cost them their lives,” Dr Oryema says.

Bumpy ride

In 2019, the provisional maternity ward—built by the Health ministry—started operating. Dr Oryema tells Sunday Monitor that they could not build a new maternity block inside the facility following the Nema directive.

“We are not supposed to put any new structures here and that is why the district decided to get a new site [where the provisional maternity unit now sits],” he tells Sunday Monitor.

Dr Oryema says mothers booked for caesarean section deliveries are driven from the provisional maternity unit to Pakwach Health Centre IV.

“All emergencies like operations, we have to ferry mothers from the [provisional] maternity [unit], which is two-and-a half kilometres away to the theatre here to conduct operations and immediately we have to transport the mothers back to the maternity on the rough road,” Dr Oryema says.

This process of transiting the mothers to-and-from the facility is not just hectic and risky, but dangerous to a mother, who has just undergone the procedure, Dr Oryema says.

“This is a big challenge because this mother, after the operation, needs enough rest and must not move that long distance. There is a high possibility that the mother can get infected along the way as she is being transported back to the maternity ward at the new site,” Dr Oryema explains.

Dr Paul Ajal, the District Health Officer, says thus: “There is a need to transfer the whole facility from the old site to the new site and the Ministry of Health has committed itself in writing, approving the transfer of the facility from the old site to the new site.”

Limited facilities

Whereas the Ministry of Health standards prescribe that a health centre IV should have 25 beds for admissions, this facility gambles with at least 72 beds for admissions.

“The facility by standard should serve a population of 20,000 people,” Dr Ajal says, adding that the 72 beds it runs “are not even enough while we serve more than 30,000 patients annually.”

He concedes to the fact that the health centre is overwhelmed.

Dr Ajal adds that the facility serves as a hospital “…without the resources required by a hospital”, which he says compromises the quality of services.

Consequently, Dr Oryema is pleading with the government to fast-track the upgrade of the facility to a district hospital to boost their capacity in terms of structures, equipment and manpower to handle the big number of mothers who come for maternal health services.

“Our prayer is that the Ministry of Health should improvise and put for us a new theatre next to the maternity ward,” he says, adding: “This will relieve us from the challenge of moving these mothers to a long distance and the risks of them contracting infections in the process.”

He further asks government through the Health ministry to upgrade and make the facility a district hospital.

“... because, through that upgrade, the supply of essential medicines and equipment here will increase and that would help us accommodate the pressure and the challenges we have,” Dr Oryema says.

 Pakwach health centre

Pakwach Health Centre IV sits approximately 300 metres away from the main bridge of the River Nile and less than 100 metres from the river bank on the Karuma-Aura Highway in Pakwach Town Council.

It is the only Health Centre IV in Pakwach District, serving as the district referral health facility.

Pakwach Health Centre IV was started as a dispensary in 1958. It was later upgraded to a Dispensary-Maternity Unit (DMU) in 1980.

In the early 1990s, it was uplifted to Health Centre III and attained Health Centre IV status in 1999.

As a district referral health facility, Pakwach Health Centre IV serves a population of 194,757.

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