Adjumani General hospital cracks away, earlier report warns the facility is unfit for harbouring human life

By Beatrice Nyangoma

Adjumani General hospital structures have developed cracks causing worry that it may collapse on patients. The cracks started with the Out patients structure in 2012 that was last year rebuilt, according to Michael Ojja, the hospital administrator.

Ojja says that the cracks have developed in the rest of the hospital walls and some of the wards have now been corded off because they may fall any time.

“We are afraid that the hospital walls may fall on to the patients any time. We have now decided that some of the wards be vacated for the safety of the patients.” he said

He however notes that the Ministry of Health and the district leaders have not supported the hospital to get funds such that renovation works can be done despite a warning report on the state of the hospital.

In January 2014 a joint team from the Ministry of Health and the Belgian Technical Cooperation declared parts of Adjumani hospital “unfit for harbouring human beings”.

According to Ojja, by the time the assessment was made three years ago, structures which had cracks on the walls included the out-patient department, the hospital boardroom and maternity ward. He however notes that the cracking has now included the patients’ wards.

A preliminary report showed that the soil texture cannot carry the weight of the structure, and that there was a problem with the design. The team recommended that the affected parts of the structure be demolished before general renovation takes place.

The hospital was constructed for the 232,813 people of Adjumani in 1997. However, according to Ojja the hospital now receives additional population of refugees of 217,000 meaning the facility is recording almost of the population planned for.

Statistics from the hospital show that in the 2015_20016 financial year, Adjumani hospital received at least 67,361 patients at the out-patient department, conducted 1,887 deliveries and admitted 10,937 patients.

Ojja however notes despite the sky rocketing number of patients, the hospital budget has been cut to almost a half. “This hospital was constructed  with a bed capacity of 100 patients but we are operating on a 200 bed capacity meaning that half of the admitted patients actually sleep on the floor. Between 1997 and 2001, we used to receive over 200 million Shillings every financial year but this has reduced to less than 130 million Shillings.” he said

He adds that the hospitals only source of local financing which is the private wing has also been frustrated by local politicians who opposed to charging  patients.

“The local politicians have failed our efforts to complement on the government funding. They stopped us from charging patients in the private wing claiming that this is a public facility and therefore services must remain free of charge.” he added

He says that the hospital received 2 billion shillings from the government that saw the outpatient structure reconstructed adding that the hospital now requires over 10 billion shillings for general reconstruction.

Dr. Sarah Byakika the commissioner for planning at ministry of health on the sidelines of  the African Regional Meeting during the Harmonisation for Patient-Centred Universal Health Coverage meeting in Entebbe, Uganda on the 5th of July 10, 2017 said that the government has not yet got funds for the reconstruction of the hospital.

“The ministry of health is aware of the Adjumani hospital needs but we have not yet got funding. We have however renovated some other hospitals that fall in the category of Adjumani hospital.” she said

Dr. Mugagga Kaggwa, a medical Officer with World Health Organization with specialization in Health Management during the says that the government should focus on strengthening the infrastructure in order to achieve a patient centred health care.

“WHO is now focusing on health care that is patient centered and Uganda cannot achieve this if we undermine the quality of the health facilities that house the patients. The state of the health facilities contributes a lot to the psychological state of patients.” he said

beatricenyangoma@gmail.com

 

How shortage of human resource is affecting service delivery at Jinja Regional Referral Hospital

By Beatrice Nyangoma
Human resource is the biggest component in any health care system. However, Uganda’s health care services have been affected because generally there is a shortage of medical doctors.
Jinja Regional Referral hospital a facility located in Jinja town and it serves a population of the entire Busoga region that is over 60,0000. The hospital receives  referrals from health centres in the districts of Iganga, Buikwe, Namutumba, Luuka, Mayuge, Bugiri, among others. However one of the biggest the challenge the hospital is faced with is shortage of health workers.
Dr  Dan Baliwo Nsereko, the Deputy Director the hospital has decided to close some of the hospital units such as the cancer treatment center.The centre was refurbished with support from Twegaite International Organization; a US based non-government organization bringing together Ugandans from Busoga region and their friends in the diaspora.

The centre was refurbished in response to government’s plans to decentralize cancer screening and treatment. However, the centre has remained under lock and key leaving cancer patients with nowhere to turn for help.

He says the facility can accommodate 50 patients but lacks equipment and staff to run it.  According to Dr Nsereko, the centre needs an oncologist, a surgeon and at least three nurses.

He says currently all suspected cancer patients are referred to Uganda Cancer Institute-UCI for treatment.

James Wako, a prostate cancer patient from Namulesa village, says he spends at least  50,000 Shillings to travel to UCI for treatment, adding that at times he has to wait for days when the institute lacks some drugs.

“It is very expensive for me to travel every month to get drugs as simple as Morphine. If Jinja ward was operational, I would be happy,” he said.

According to Alitwala, the number of mental health patients has almost doubled in the previous three months. She explains that they used to receive between 20 and 30 patients daily, but the number has increased to over 60 patients.

Alitwala also notes that the unit is faced with a challenge of essential drug stockouts, adding that they have spent over two years without receiving Phenytoin and Injectable Fluphenzine, the two most essential drugs for mental illness.

Sarah Mudondo, a care take to one of the patients who has spent four weeks in the facility. She says that she spends more than Shillings 20,000 on drugs and food daily.

Alitwala emphasizes that the failure by the hospital to provide meals to the patients is a big setback. She says that in most cases they are forced to suspend medication to patients especially with HIV when they learn that the patient has not eaten.

She also cited insecurity as another challenge in the hospital. The mental health unit relies on the guards at the main gate, which is a very long distance from the unit.

“We have two nurses on night duty and there is a time when a patient wanted to strangle a nurse.  They had had to call security personnel at the main entrance, which is very risky,” she said.

The hospital’s intensive Care Unit also lies underutilized due to lack of specialists. The 13-bed ICU unit is the largest in eastern Uganda.

The 5 billion Shillings facility, donated by ASSIST International, was commissioned in September 2011. It is equipped with cardiac monitors, ventilators, pulse oximeters and defibrillators capable of treating patients with critical illnesses of the lung, heart and kidneys.

It was expected to serve patients in eastern Uganda and reduce referral cases to the National Referral Hospital in Mulago.  However,  the hospital does not have the technical expertise to run the facility.

An ideal intensive care unit requires doctors with specialty in anesthetics, cardiology and emergency medicine. It also needs physiotherapists, dieticians, speech therapists and nurses. The role is nurses is however limited to delivery of medicines, prescribed by the doctors and monitoring blood pressure, heart rate and oxygen levels.

However, the ICU at Jinja Referral Hospital does not have all the specialists needed to keep it functional.

The hospital principal Nursing Officer Aceng Florence says that the facility requires at least 30 nurses to operate effectively. She notes that at the moment, they cannot admit more than three patients at a time due to shortage of staff. The unit has only three nurses.

In an ideal situation, according to Aceng, one patient should be attended to by at least four nurses, and 12 nurses should therefore be in place to work every 24 hours.

Christine Akello, one the nurses at the unit says that running the unit hectic especially when there are emergencies such as accidents. She notes that since the start of this year, the unit has admitted only 11 patients and others have been turned away because there are no doctors to attend to them.

Muhammed Khalifa Mbhete, the Jinja central division Councillor and chairperson of the health committee says that the state of Jinja hospital is generally appalling. He notes that every department in the hospital has an essential component missing.

However, like other units that lack staff, there is hope that the unit will get more staff following a request by the hospital administration to the Health Service Commission two years ago.

beatricenyangoma@gmail.com

Eye patients appeal to government to train more specialists

By Beatrice Nyangoma

 

On  27th June,2017, Gilbert Onegi 43 a resident of Oduk village, Abira West Parish in Zombo district trekked a distance of over 50 kilometers to Nebbi hospital to have his 3 year old Jonathan Rwot Omiyo treated of an eye complication.

Onegi’s travel to Nebbi hospital followed radio announcements that the hospital would be hosting a medical camp where several eye specialists would provide eye screening and treatment services at no cost.

To Onegi, this was a life time opportunity to have his son who had suffered for three years of an eye complication treated and have a new life free of pain.  Onegi ensured that he was at the hospital by 8am so that he is among the first people to be attended to. However, by the time he arrived, he found over 50 other patients lined up for the same service.

Because of the severity of the condition of Rwot’s eye, the doctors made Onegi jump the line and he was seen among the first patients.

Rwot’s left eye is protruded from the ball, red in color and it is teary. His father says that the eye started swelling when he was four months. He says that efforts to get treatment from different medical facilities were futile as all the medicines prescribed were not helpful while the swelling continued.

“This boy has been staying with his mother who left me for another man. For almost a year, I have been sending some money to her mother for treatment but things never changed. But at the start of this year, I decided to pick him and I have since been looking after him. But he cries every night because of pain. When I heard about this camp I borrowed money to bring him.’ he said

But according to Dr. Ben Watmon an eye specialist from Gulu Referral hospital said  the boy’s eye condition is one known as Retinoblastoma cancer which is in its advanced stages and may be difficult to reverse. He said that from the clinical observations, the tumor is already grown and is visible.

“This type of eye infection starts in babies as early as one month. During the night, the eyes close as that of a cat. This eye is now a burden to the child and therefore we have to remove it to reduce the pain but also prevent the suspected cancer cells from spreading into the body and then he will start on chemotherapy.

Ideally, chemotherapy should have been the first thing to do then the eye is removed but since it’s too late we shall remove the eye and then refer him to  Ruharo hospital in Mbarara district which is the only facility in Uganda that gives chemotherapy services. This boy could have maintained the eye but because we have few eye specialists in the region, he could not get early screening.’ He said

Uganda is a signatory to the World Health Organization strategy for elimination of avoidable blindness by the year 2020. Figures from the Health Management Information System indicate that eye diseases are among the top ten causes of morbidity in Uganda. It is estimated that between 300,000 to 350,000 people in Uganda are blind and over 1.2 million have visual impairment.

However, despite the commitment, Uganda is faced with acute shortage of ophthalmologists (eye specialists). According to a 2012 report by Sightsavers International, a charity organization dealing in eye related illness in Uganda, there are only 41 eye specialists, of which 26 of them are in Kampala while only 15 are shared by the rest of the country.

Dr. Charles Keneddy Kissa the Nebbi Hospital Medical Superintendent says that the hospital has a fully equipped eye clinic but it is non- operational because it lacks a specialist. He says that  patients with eye related complication are referred to Arua Regional Referral hospital which is over 70 kilometers away. He however adds that the hospital operates an outpatient eye  clinic that manages minor eye diseases such as allergies.

The burden of eye diseases at Nebbi hospital

 

Dr. Kissa says that the hospital registers a big number of people with eye problems. He say in the financial year 2015/2016, the hospital recorded 1,180 eye patients out of the total 49,809 patients which is about 2.3 percent.

“This is a big number of people most of whom end up losing sight which could be reversed if we had an eye specialist. We now depend on well -wishers who offer to treat our patients through medical camps.” he says

During such camps like the one that started on 26th June Monday and ended on Friday 30th July, very many people turn up because there is a service delivery gap.

The camp was organized by Ministry of Health with support from Amref Health Africa, attracted a total of 106 patients of which 42 underwent corrective surgery. “We had planned for round 80 patients from Nebbi district. However, we got more patients coming from as far as Zombo, Pakwatch, Arua while others come from as far as Democratic Republic of Congo.” He said

He adds that due to logistical challenges, many of the patients go unattended to nd instead priority is given to those who have higher chances of recovery.

Information obtained from the Health Management Information System indicates that between 300, 000 to 350, 000 people in Uganda are blind and over 1.2 million others have visual impairment.

Dr. Wotmon noted that of these, 170, 000 are blind due to cataract and that the number increases annually by 20% representing 34, 000 new cases every year.

Cataract is the clouding of the eyes. The clouds change the lens of the eyes leading to sight loss or reduction. Cataracts are common among the elderly but children and other age groups can also succumb to this condition. Patients suffering from cataracts can regain their vision only if they undergo a minor surgery. However, Watmon notes that many of the patients resort to using traditional herbs instead of seeking medical attention.

In order to deal with this, Dr. Wotmon said, the country needs to carry out at least 34, 000 cataract operations annually. But he said that unfortunately government is currently able to conduct only 10, 000 cataract operations annually, leaving the lives of the eye patients at big risk.

However some of the causes are preventable. The preventable causes of blindness and visual impairment include cataracts, trachoma, Onchocerciasis (River Blindness), vitamin A deficiency, measles, and injuries on the eyes, bacteria, viruses and fungus among others.

Dr. Kissa however appeals to the government to train more eye specialists such that the hospital can attend to patient on a daily basis.

“Whereas the medical camps are very important in service delivery to eye patients, they are not sustainable and they are expensive. For example the hospital has to feed the specialists that come to treat during the camp period and also provide some of the consumables. By the time the camp ends, we find the medical supplies are out of stock.” he said

He also adds that in cases where partners support medical camps, the health ministry should also support more by providing consumables that are very expensive such as the artificial lenses that cost round 1,000 dollars each which is about Shs.3, 500,000.

The Ministry of Health notes that vision impairment is the leading cause of disability. Worldwide about 45 million people are blind while 135 million others have visual impairment.

beatricenyangoma@gmail.com