The main gate of Mbale Regional Referral Hospital. A cartel involving guards, clinicians, doctors, and others often refer patients to nearby private facilities. PHOTO/YAHUDU KITUNZI

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VIDEO: How extortion rings risk patients’ lives at Mbale Hospital

What you need to know:

  • The Ministry of Health has revealed that only 30 percent of the patients who seek healthcare in public health facilities are satisfied with the services, a testament that the country is not adhering to international standards. 

The lives of patients at Mbale Regional Referral Hospital precariously hang by a thread as cartels rule the roost. When Florence Manashe checked arrived at the hospital in Mbale City on April 7 for a minor operation, little did she know of the perils that lay ahead.

Three days earlier, the 54-year-old resident of Kwar- Kwar Cell, Kongunga Town Council in Bukedea District had travelled to the hospital. 

She spent two days without being attended to, a tactic that is routinely employed by health workers, according to our investigations.

Unknown to her, a broker hanging around the hospital corridors was closely on her trail. 
On the third day, a person claiming to be a ‘senior doctor’ offered help after hearing about her plight.

The ‘good Samaritan’ told her to take a shower and prepare for the surgery later but at a private clinic 600 metres away from the mortifying wards where she had been barely attended to. She keenly followed the stranger’s advice.

About two hours into the theatre at Spi Medicare Health Service Clinic, Manashe was pronounced dead.
City authorities were immediately alerted when it emerged that the deceased had been operated on by two unqualified doctors. Distressed relatives sought for answers but in vain.

Ms Mariam Mutonyi, the deceased’s sister, said her sibling was picked from the hospital ward by someone who claimed to be a doctor elsewhere.

“Later the owner of that clinic convinced us that he was better placed and equipped. We heard the news that she had passed on,” Ms Mutonyi said.

Another death. Another statistic of the country’s moribund health sector where hundreds of grieving relatives are called to morgues to pick up the bodies of their loved ones without receiving answers.

Many families cannot afford to file suits on the ground of medical negligence or lodge formal complaints to the Uganda Medical and Dental Practitioners Councils, the medical workers’ umpire. There is also little awareness about these corrective measures.

The chairperson of Mbale City private clinics owners, Dr Dominic Wabuloko, said the health facility where Manashe died belongs to a nurse who is not supposed to carry out surgeries.

“The deceased had a big spleen and it was supposed to be removed by a senior surgeon. For him (nurse) he decided to cut it into two parts and throw another away, leading to over-bleeding,” Dr Wabuloko said.
For many patients and caretakers that have been to Mbale Hospital, the experience is terrifying. Those who cannot dig deeper into their pockets to oil the wheels of graft are condemned to fate.

Extortion galore
We pitched camp at the hospital for two weeks during which we established a cartel involving some doctors, nurses, clinicians, and administrative support staff at the blood bank, guards, and other attendants that work together with private clinics near the main hospital’s precincts.

The streets leading to the hospital’s two entrances are dotted with private clinics, pharmacies, and laboratories.

Patients and caretakers are frequently referred to private facilities that ordinarily should offer complimentary services but have turned into extortionist businesses.
Our investigations revealed several things. First, there is widespread syndicating of patients by hospital staff to private clinics. 

Medical personnel deliberately, catalyse scarcity—claim specialised personnel or essential medicines are unavailable—forcing desperate patients and caretakers to seek the services outside.Some hospital staff volunteer information about where to find services or specialists.

One of our colleagues checked into the hospital as a patient who needed assistance urgently. 
After being ignored for a few hours, the colleague was approached by a ‘sympathetic’ guard who had earlier on camped in the hospital ward.

With the guard’s assistance, my colleague was able to evade the red tape and was ushered into the nurse’s room.

He was asked for Shs1,000 to buy a 32-page exercise book for registering details of his diagnosis. 
He was sent to another room where a doctor immediately diagnosed him and recommended that he visits a private lab for tests.

At the laboratory, our colleague, who has never complained of any symptoms, was diagnosed with acute ulcers. He took the results back to the doctor at the hospital who referred him to the dispensary. 

The pharmacist told him that they only had paracetamol. For the other prescribed drugs, the pharmacist eagerly recommended a clinic where we bought the drugs.

Upon returning to Kampala, our colleague underwent a second test for ulcers whose results were negative.
Mr Steven Masiga, a researcher at Makerere University’s Mbale Centre, told Monitor that extortion syndicates at the hospital are a norm.

“There are concerns on the quality and ineffectiveness of services; the failure by the facility to do its work. In terms of buildings, the hospital is generally doing fine but regarding services, the issues there is common knowledge among the population and local authorities,” Mr Masiga said.

“The [Health ministry) PS, Ms Diana (Atwine), must do a lot of follow-up on these issues; when she was still at the State House Anti-Corruption Unit, she discovered a lot of these things but now that she is in a position of power, I wonder why she hasn’t taken action. People are dying and suffering from wrong diagnoses, operations, and prescriptions, but everyone, especially our politicians, is sleeping on the job,” he added.

Syndicates manning the hospital gates ask questions or take note of the seemingly desperate patients or caretakers. 

Pay or die
They stalk and persuade them to part with some money so that they can quickly connect them to the right doctors or medical personnel.

The guards, according to multiple accounts, work with the doctors/medical personnel. 
They identify the patients, recommend who sees who and where, and also act as the linchpins of this ‘enterprise.’

Working covertly during our two- week investigations, we were able to document several of these cases.
Mr Masiga said it is immoral for a referral hospital to be committing patients, some critically ill, to small private outfits.

“A hospital like ours can only refer to Mulago, the national referral, and in some cases to big private ones. These are wrong-illegal references they make. They condemn patients to quacks and ill-trained patients,” he said.

After several days of prodding, one doctor agreed to speak to us on condition of anonymity about the scope of the cartels. 

The doctor said the scheme starts every morning with the guards— doing client reconnaissance. 
“We have our coded language. After sometime, the guard will walk to any of us and say ‘I have spotted like two or three or four who can pay’. They bring these to us; we look at them, and in most cases refer them to clinics or laboratories for tests, x-ray scans, operations or drugs,” the source said.

A nurse injects a baby at Mbale hospital. Sometimes the hospital, according to administration, runs out of drugs. PHOTO/YAHUDU KITUNZI 

The commission, the source revealed, is dependent on how much the private facilities charge the patients. For instance, if a patient undergoes scan[s], laboratory test[s], and prescription at the same time, all three services attract a commission for the referee.

“In the evening, we pick our commission. The guards who act as brokers are paid at least Shs5,000 per patient. It is a large syndicate—askaris, cleaners, clinical officers, doctors, and nurses, and at the blood bank, they don’t give you blood unless you pay between Shs80,000 and Shs100,000 for desperate caretakers or when blood is scarce,” the source said.

The city mayor, Mr Kasim Namugali, told this publication that he is conversant with the extortion complaints.

“Last time we interacted with the hospital director, we were told that particular drugs sometimes require sourcing from outside. He took us around the hospital pharmacy and we saw people lining up to access certain drugs. Particular drugs for some ailments were not there,” Mr Namugali said.

Betting lives
Like it is the norm, he added that patients and caretakers are often taken advantage of.
“There are fraudulent people who specialise in making referrals, and when we ask, we are given all sorts of explanations some of which make sense and others do not,” Mr Namugali said.

New doctors take the Hippocratic Oath before they are released to the public to use their knowledge and skills for the good of humanity.

The oath binds doctors to protect patients by upholding professional integrity at all times; to do no harm, to care for the patient, and to maintain the utmost level of confidentiality even in death. 

But with the country’s ailing health sector peppered with a population explosion, poor pay and long hours of work, ethics are often pushed to the back burners.

Specialist doctors, who are paid a pittance at government hospitals, usually dovetail practice at private facilities where they are paid better wages while others completely switch to private practice with improved remuneration.

Last week on Monday, city authorities planned an operation to net a doctor at the hospital notoriously known to syndicate patients, but out of instinct, he jumped the bait.

Medical personnel have used poor remuneration and delayed payment of salaries and allowances as a scapegoat for their ethical pitfalls.

The regional referral hospital is also crippled with chronic absenteeism of specialised personnel. Medical interns are filling the void, which is also an issue of concern. 

Sources told this publication of syndicates using private vehicles to sneak patients from the hospital to outside facilities, and syndicates coercing patients for X-ray and scan services without meeting the doctors at private laboratories to earn a commission, among others.

“If you do a SWOT (strengths, weaknesses,  opportunities, threats) analysis, the buildings and manpower are there at least on books; it is until you go there that you won’t find them. You mostly find interns helping out, learning on the job; patients are specimens,” Mr Masiga said.

PANORAMA: How extortion syndicates hijacked Mbale hospital

The Resident City Commissioner, Mr Ahmed Washaki, told Monitor that they have in the past mounted raids to net perpetrators of the syndicates following complaints from patients. 

“It is true there is too much extortion and I have experienced it, and liaised with hospital management to bring culprits to book. The gaps are that the affected people do not report to us; whoever is asked to look for money goes to look for it instead of reporting the crime. We have mounted some operations and after that, the perpetrators usually wait after a month or two and resume the same thing,” Mr Washaki said.

“Every after two months, the National Medical Stories delivers supplies to the hospital due to the large influx of patients,” he added.

For some patients who have fallen prey to these extortion and bribery syndicates, the effect is profoundly long-lasting. 

Mr Ivan Mwana, 20, was admitted to the hospital last December following a motorcycle accident that left him with a compound fracture. After a few days at the hospital where he was barely attended to, he was sneaked out by unknown people to a private clinic in Nkoma ward, Mbale Northern City Division. The unknown people who felt “sympathy for him” it emerged later were doctors at the hospital who also moonlighted the clinic. 

At the clinic, Mwana immediately underwent an x-ray and an operation that included clamping his bones, which cost Shs1.5m. 

His caretakers were informed after the operation as they frantically looked for him. Three months after the operation, the bone clamps snapped and his injuries degenerated. 

Scans conducted later showed the first operation was poorly conducted. For a new corrective operation, he required Shs4.5m which he doesn’t have.

Dr Wabuloko said several private clinics outside the hospital operate without a license.
“We don’t have good supervisory systems. The people who are supposed to supervise these clinics are after money. There is a need to eliminate the menace of quackery. We agreed to have an operation against the quacks,” he said.

Mr Masiga called for shutting down clinics around the referral hospital which could perhaps scuttle these cartels. 

President Museveni in his February 8 letter to the National Drugs Authority (NDA) ordered for the immediate closure of all private pharmacies operating within government health facilities barely after the interdiction of the former Mulago National Referral Hospital’s executive director, Dr Baterana Byarugaba.

However, the administrators at Mbale Hospital continue to conduct business in disregard of the President’s directive as it is only a matter of time before another tragedy unfolds.

About the hospital

The British colonial administration established  Mbale hospital 98 years ago. The 415-bed facility serves more than 15 districts in eastern region, including Busia, Budaka, Kibuku, Kapchorwa, Bukwa, Kween, Butaleja, Namisindwa, Manafwa, Mbale, Pallisa, Sironko, and Tororo.The comfort that the recently retrofitted Shs22b surgical complex remains a far cry.

The hospital boasts of structures in fairly good condition but is short on equipment and specialised personnel, and yet according to the Health ministry, the facility is one of the most staffed hospitals among the 16 regional referrals in the country.

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