Covid-19: What exactly do you spend on in hospital?

As the second wave of the Covid-19 pandemic continues to wreak havoc, relatives and friends of many patients admitted to various hospitals across the country say they are choking on the high bills they have to pay on a daily basis.

A survey done by Daily Monitor shows that most public and private health facilities have made a breakdown of costs for different equipment that the admitted patients must shoulder on a daily basis. 

For instance, equipment such as the oximeter, which reads the oxygen saturation levels along with the heart rate; gas cylinders, ICU beds, and ambulance services, are always billed individually.

For a patient admitted to the high dependence unit (HDU) at a private hospital in Kampala, they have to part with at least Shs2 million as cost for treatment every day.

For example, on a daily basis, a patient has to pay Shs300,000 for oxygen, Shs100,000 for a physician, Shs150,000 for a doctor and Shs200,000 as risk allowance for the two nurses assigned to him or her.

The patient also pays additional Shs250,000 for the isolation room and an average Shs400,000 for drugs administered to them every day.

For patients admitted to the intensive care unit (ICU), the costs even go up to between Shs3 million and Shs6 million.

Mr Joshua Edongu, the Soroti City mayor, said they spent more than Shs60m at Rubaga hospital in Kampala where his brother Joseph Olungura and his wife had been admitted for Covid-19 before they died last week.

He said the money was spent on intensive care unit treatment and several tests that medical workers needed.  Olungura was buried last Thursday and the wife was also laid to rest last Sunday.

Dr Denis Kutoosi, a medical worker at Cure Hospital in Mbale City, says the treatment charges depend on a patient’s condition and status.

He notes that it is cheap to treat a Covid-19 patient who can still breathe without support but becomes very expensive when the patient needs to be taken to the ICU or HDU, where he or she requires oxygen.

“If the patient is breathing well, it is cheaper to treat the virus but if the patient can’t breathe well and needs oxygen support, then it becomes so expensive and few can afford that,” Dr Kutoosi says.

He explains that patients on oxygen at their hospital are charged an average of Shs20,000 per hour.
“This rate becomes very expensive for poor patients who first of all struggle to raise a single meal to eat in a day. Remember some patients can stay in  ICU for weeks, leave alone the costs of drugs, oximeters, and other things that they will be charged for,” Dr Kutoosi says.

Experts speak out
Dr Richard Mugahi, the head of quarantine and airport operations at the National Covid-19 Taskforce, says the cost of treating a patient depends on his or her condition.

“Some patients who are in critical condition may spend 20m to 60m or above because the patient needs to be in the ICU. In some private hospitals, a patient pays 5m per day for ICU while testing is 65 dollars,” Dr Mugahi says.

According to him, there are even hospitals that are charging Covid-19 patients up to Shs2 million per day for oxygen.
“Some hospitals charge Shs2 million per day and remember the minimum days for one to be treated of Covid-19 is 14 days but others spend more than 14 days in the hospital while under intensive care,” he says.

But Ruharo Mission Hospital, a private health facility in Mbarara City, offers free Covid-19 testing and free treatment for only asymptomatic patients.

The severe cases are referred to the Covid-19 treatment centre at Mbarara Regional Referral Hospital, according to Dr Beckson Tayebwa, the facility’s medical superintendent.

“We do Covid-19 testing for free and treat only those with symptoms because we don’t have Covid-19 treatment centre. We treat those with symptoms with an oral medication that goes between Shs30,000 and Shs50,000,” Dr Tayebwa says.

He notes that some of the treatment given to those with mild Covid-19 symptoms include Zinc, Azithromycin, and Vitamin C.
In many districts, the shortage of oxygen and beds has made the situation worse.

In Obongi, for example, the district has an isolation facility of eight (8) patients only and yet there are no oxygen cylinders to manage critical cases.

“Our health facility is not a hospital, it is a health centre IV, and so we refer critical cases that need oxygen to Arua general referral hospital or Moyo hospital,” Mr Dominic Lomurech, the acting district health officer for Obongi, says.

But such transfer costs have to be met by a patient, this newspaper established. For a patient to be referred to either Adjumani, Gulu, Arua or Kampala for critical management, they have to part with at least Shs900,000 to fuel the ambulance.

Dr Franklin Iddi, the Moyo District health officer, says Moyo General Hospital is not only challenged by lack of oxygen cylinders but also faces erratic power supply, especially for its ICU section that currently has eight Covid-19 patients. In

Adjumani, the health authorities are currently grappling with a shortage of basic facilities to manage the overwhelming Covid-19 numbers.

Shortage of equipment
Dr Michael Ambaku, the medical superintendent of Adjumani hospital, says the number of Covid-19 patients keeps on increasing every other day yet they lack basic equipment.

“On June 11 alone, the hospital detected four new cases while Dzaipi Health Centre III recorded 14 cases, which were already too many because we have run out of basic medications to handle the cases,” Dr Ambaku says.

Adjumani now has 333 positive cases with 7 deaths. Of the 333 cases, 56 are refugees.
“Due to lack of capacity, we are now encouraging home-based care management,” Mr Data Taban, the Adjumani RDC, says.

At some isolation centre at public hospitals, patients are having to shoulder the treatment costs even when such services are meant to be free.

At the isolation centre in Kabale District, for example, a patient spends between Shs250,000 and Shs500,000 on diet and food supplements for the 10 to 14 days.

Covid tests
In the district, whereas Covid-19 tests are free at Kabale hospital, private clinics charge between Shs20,000 and Shs50,000.
Dr Sophie Namasopo, the director of Kabale Regional Referral Hospital, says Covid-19 tests are free. She adds that they have stocked enough oxygen at their processing plant for patients.

Covid-19 positive cases in the district have increased from 112 (as recorded on Monday last week) to 350 cases by last Saturday.

Mr Alfred Besigensi, the acting district health officer, says several Covid-19 patients are being advised to go for home-based care while those in critical condition are admitted to Kabale Regional Referral Hospital.But home-based care comes with its own set of challenges.

Mr Edward Kafeero, a journalist in Mubende District, says after testing positive for Covid-19, he was advised by doctors to use Dexamethasone and flu tablets in addition to a concoction of ginger, lemon, honey and other fruits. Mr Kafeero says for the seven days he was on treatment, he paid Shs30,000 daily .

“Getting fruits is hectic because they are apparently scarce in the whole of Mubende, I had to pay some money to a boda boda rider to look for them in the suburbs,” he says.

Ms Kevin Achan (not real names) and her 17-year-old son, an S.3 student, tested positive for Covid-19 at Gulu University laboratory last week.

But Ms Achan betrayed the treatment protocol and would still go to Layibi market at Lacor Trading Centre to operate her stall of vegetables and fruits.

“When both of us turned positive after tests, we were counselled and asked to buy drugs and other requirements for the home-based case at a cost of Shs52,000 per week,” she says.

She said that she could not stay home anymore for the second week since she ran out of money but needed food to live on.
Ms Achan is among the 400 Covid-19 patients under home-based care who have been accused by the Gulu District Covid-19 taskforce of violating treatment rules and spreading the virus.

Oxygen shortage 
Recently, Dr Richard Idro, the president of the Uganda Medical Association, said health workers have been overstretched and that the country is headed for an oxygen crisis as it happened during the Covid-19 surge in India.

“Severely sick Covid-19 patients require a lot of oxygen, these large cylinders of medical oxygen cannot support them. If we allow this disease to go out of hand, we shall run out of medical oxygen in the country and we will lose very many people,” he said.

By Simon Emwamu, Tobbias Jolly Owiny, Taibot Marko, Rajab Mukombozi, Ivan Tolit, Robert Muhereza, Olivier Mukaaya, Alex Ashaba & Al-Mahdi Ssenkabirwa