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

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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.

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Unsafe Abortion:Health advocates drag Uganda’s Parliament to Court

By Beatrice Nyangoma

Dr. Charles Kiggundu a Senior gynacologist at Mulago National Referral hospital sees atleast 15 women who have undergone unsafe abortion. These are as young as 9 and 15 years and as old as 40 years.

He says that these have various reasons why they decide to terminate pregnancies.

“I have a university student who has been impregnanted five times by her father and she has procured abortion five times. Many girls opt to terminate pregnancies that are as a result of incest and rape.”he says

He says that as much as this girl can afford to have a safe abortion, many of the others use rudimentsry means to terminate pregnancies.

Dr. Kiggundu emphasises that lack of a clear legislation in Uganda has led to many girls and women procuring unsafe abortion most of whom resulting into deaths.

“Unsafe Abortion continues to constitute a serious public health, human rights and social equity issue that affects millions of women in sub – Saharan Africa, and causes 29,000 deaths annually.”he says

“Women of all social standings seek abortion services, but it is mostly young women and poor women who die or suffer long term consequences from unsafe abortion due to the severe socio-economic deprivation they encounter. Providing access to safe abortion is a critical step towards reducing the unacceptably high rates of maternal death in Africa.” Kiggundu notes  

According to World Health Organisation, of the 6.4 million abortions in Africa carried out in 2008, only 3% were safe. One quarter of unsafe abortions occurred among adolescents aged 15-19, and 60% were among women under age 25. Additionally, unsafe abortion accounts for 13% of global maternal deaths and up to 40% of maternal mortality in African countries.  

Meanwhile, Uganda has one of the highest rates of unsafe abortion in Eastern Africa. It is a leading cause of maternal morbidity and mortality in the country, contributing to approximately 26% of the estimated 6,000 maternal deaths every year, and the estimated 40% of admissions for emergency obstetric care. Unsafe abortion places a huge cost on the public health system; approximately Ushs 7.5 billion are spent annually to treat complications.

A national abortion incidence study found that 15 out of every 1,000 Ugandan women of reproductive age were treated for abortion complications in 2003. Poor, rural women are at increased risk of unsafe abortion, 68–75% experienced complications, compared with the 17% complication rate for non-poor urban women.

According to Kiggundu, Uganda’s restrictive abortion laws permits abortion only to save the life of a pregnant woman. However, conflicting and restrictive interpretations of the abortion provisions under the 1995 Constitution of Uganda, the Penal Code Act and National Reproductive Health Policies have created confusion about the correct legal status of abortion.

According to a study conducted by Human Rights Awareness and Promotion Forum- HRAPF between 2011 and 2015, in seven main police station in Kampala, atleast four people were arrested every year in relation to abortion. Linette du Toit, the Research and Advocacy Officer at HRAPF says that nationally 182 arrests were made on abortion charges noting that few of the health workers are arrested.

Its a gainst this background, that  Prof. Ben Twinomujuni a Law don at Makerere University together with Center for Human Rights and Development-CEHURD filed a petitioned seeking that the constitutional court  orders the Executive and Legislative arms of government to pass a law  regulating termination of pregnancies to reduce maternal mortality rates that arise from  unsafe abortions.

The law dons in their petition filed on March 3 2017, contend that the existing legislation only permits abortion in exceptional circumstances such as a life of a mother at risk, but doesn’t protect young girls and married women who may get unwanted pregnancies hence resorting to unsafe abortion methods.

The petitioners argue that other African countries like Kenya, Rwanda, Ethiopia, Ghana and Tunisia, which are similar in social and economic circumstances as Uganda, deliberately developed laws to protect the rights of women by prescribing circumstances under which a woman is allowed to terminate her pregnancy.

“We do not see any reason as to why Uganda should not borrow a leaf from its neighbours and take an essential step to   protect the lives of women who continue dying day by day due to unsafe abortions,” reads part of the petition.

“Because the government has not operationalized Article 22(2) of the 1995 constitution of Uganda as a way of clarifying the parameters for legal abortion, healthcare providers are unable to provide safe and legal abortion services, while law enforcement officials and judicial officers do not effectively enforce or implement laws that permit abortion thus denying women and girls access to safe and legal abortion services.”Twinomujuni notes

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How lower health centers struggle to operate:A case of Njeru Health Center III

By Beatrice Nyangoma

On a rainy Tuesday morning, Agnes Kirabo braved the cold and by 8am, she was in the queue for her third antenatal check-up from Njeru health center III located in Namwezi village, Njeru West of Buikwe district.

She is expecting her third child and she was the 31st patient to register at maternity ward of the facility.

 Kirabo says that she has to spend at least four hours before she is attended to because the queue is always long .

But the most worrying thing for Kirabo is the fact that she will have to deliver her baby from another hospital.

“I have to save money for transport to Jinja Regional Referral hospital at the time of delivery because Njeru health centre does not admit patients. I always have to spend over 100,000 Shillings whenever I go to another hospital to deliver.”she says

Sarah Nakigozi , an enrolled nurse at the health center says that the facility records close to 200 patients everyday and yet its premises were constructed in 1973 for not more than 30 patients as a private health centre.

She however notes that the facility was not expanded when government took it over in 2001.The government’s take over of the facility was after the residents raised concerns about lack of a health centre III in the area.

She however adds that even the patients are in most cases turned away because the unit rarely has drugs in stock. She says that National Medical Stores-NMS supplies drugs every after two months. She however notes that the drugs supplied are less compared to the number of patients adding that some times the drugs are consumed within just one week.

Nakigozi adds that most HIV/AIDS and TB patients are referred to St. Francis hospital, a non governmental facility where free services are offered while others are referred to Jinja and Kawolo hospitals.

 She also notes that the facility has staff shortage of six people. She adds that the eight people at the facility are very few and yet the number of patients is overwhelming.

The centre is also in toilet crisis since they filled up two years ago. Nakigozi says that the health unit administration decided to close down the toilets after they failed to get money maintain  them. She however adds that the toilet crisis endangers the lives of the workers and patients.

Margret Hashasha, the deputy speaker for Njeru Town Council notes that efforts by the council to secure funds to buy land to relocate the centre have been futile because of the limited budgets. She however notes that the council has secured 20 million to construct a waterborne toilet this financial year. 

She says that the facility records a huge number of patients because the district lacks a district hospital and yet Njeru health centre is located on the highway. She adds that the centre is bridging the distance between Kawolo and Jinja hospitals which would be the other options. Most of the patients come from Najjembe, Lugazi, Wakisi and Njeru municipality.

Hashasha also told that the council has started on the process of elevating the facility to a health centre IV or constructing one in another area to ease the burden on Njeru health centre. She however adds that this the council is yet to find funds for this transition.

She says the facility serves a number of patients but the challenges it has need to be urgently addressed.

Between 2000 and 2015, Uganda has reduced the maternal mortality ration from 560 to 368 per 100,000 and under five mortality from 687 to 343 per 1000rate albeit at a slow pace.

Health advocates have attributed the slow progress to shortages in human resources for health, persistent stockout of drugs inclusive of family planning and reproductive health commodities and poor infrastructure, among others.

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Leprosy: The curse beyond imagination

By Beatrice Nyangoma

Sylvia Namugerwa a 24-year  resident of Buikwe district has been battling with leprosy for the last seventeen years. She says that people look at her as unclean and they don’t allow her to socialize with them for fear of infecting them.

‘’ I was very beautiful but I lost my beauty due to leprosy, the father of my three children also left me ,people also shunned me because of the disfiguring skin sores  and this stresses me but if we are in our own camp as leprosy patients it can help us,’’ she says.

74-year old Patrick Mujjasi a resident of Wabulungu B village ,Wairasa sub county in Mayuge district was dumped  at St Francis General Hospital, a national Leprosy Referral Center inBuluba Sub County in Mayuge district by his family members. He says that throwing him at this facility is the best he could get given the mistreatment he suffered while at home.

“My wife divorced because of my appearance ,I can’t dig, am deformed my fingers and toes become shortened ,both the relatives and the community segregate me they can’t even eat with me.”he says

” I appeal to the Government  to establish a camp for people suffering from leprosy so that we can stay there,’’ he adds

Most of the leprosy patients may share the same feelings as Mujjasi and Namugerwa. The feeling of not fitting into society because of this imaginable illness.

Leprosy  also known as the Hansen’s Disease is a chronic infectious disease that primarily affects the peripheral nerves, skin, upper respiratory tract, eyes, and nasal mucosa (lining of the nose).

 St Francis General Hospital administrators say that they are registering a rise in the number of leprosy patients.

Henry Katende the facility Superitendant says that they are overwhelmed by both patients and former patients who flock the facility because they have been abandoned by their relatives.

He notes that unfortunately, many of the people show up for treatment when it is too late. He says that this is caused by the fact few hospitals do screening for liprosy and in cases where they do, they sometimes misdiagnose becase they lack enough information about loprosy.

‘’ In 2016 we received 41 patients who were diagnosed by leprosy compared to 25 in 2015  an indication in the increase in the number of patients with the diseases and one case per 100,000 population  are suffering from leprosy in Uganda ,’’  Katende said

He however notes that future of liprosy patients is uncertain since the main funders- the German Leprosy Relief Association are withdrawing this year.

“Germany Leprosy  Relief Association is withdrawing  funding  which it has been providing to the hospital in terms of paying staff, supplying medicine, dressing them  and feeding. One of the reasons for their withdrawal is that the hospital has since become a general hospital and yet their mission was only Liprosy”. he adds

He explains that Leprosy affects mainly the three body parts including the hands, feet and the face which makes the patient unable to close the eyes hence making him or her prone to injuries.

“Leprosy is a chronically infections bacteria disease .it mainly affects the skin ,the nervous system ,the eye and the respiratory system but early detection remains the best way to minimize the spread of leprosy because once detected  and put on treatment , the spread is minimized and the  patient’s immunity remains strong to counter other infections but if left untreated ,it can progressive ,causing permanent damage to the skin ,nerve, limbs and eyes ,’’ he said

The Cardinal signs of leprosy include  punche like a ring worm, muscle weakeness, , pain of certain body parts which can cause numbness in the hands, arm, feet and legs, skin lesions and its  incubation period ranges from three year to thirty.

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What if Uganda Distributed Reusable Pads for School Girls?

By Beatrice Nyangoma

There is heated debate  among Ugandan activists who think government has failed to prioritise menstrual hygiene among school going girls.

Others have reached an extent of fundraising for the cause. This follows Uganda’s minister of Education and sports Janet Museveni who also doubles as the first lady admitting that the government does not have funds for the pads.

During the 2016 campaigns, Uganda’s president Yoweri Kaguta Museveni pledged that he would prioritise provision of pads to the school going girls. But since his victory in February last year, the pads pledge never came to pass and the latest revelation by Mrs.Museveni indicates there is no hope of honoringit.

Research by Build Africa released in 2013 revealed the alarming statistics and impact this issue has on girl child retention in schools and completion. On average, the report revealed that of the 80 days allocated to a school term, 29.7% of the adolescent girls said they miss a minimum of four days per cycle.

This also includes examination days, important class presentations and the introduction of new topics. Another 24.3% of the girls spoken to admitted to being stigmatised whenever they soiled their uniforms and as a result, they opt to stay at home until after their periods.

But Health Journalists Network team hosted some of the partners with which government works to implement menstrual hygiene explained the options available for the girls to ensure good menstrual hygiene.

Pilot studies conducted by UNFPA and Straight Talk Foundation about use of reusable pads indicate  that actually more girls can stay in school if they are supplied with a pack of reusable pads. 

UNFPA’s Dr. Edson Muhwezi says that pilot studies conducted in schools where they have supplied Afripads indicate that girls have not only stayed in school but the infection rates as a result of poor hygiene have also reduced significantly.

He however notes that their experience indicates that  its not just provision of pads that really matters. There is also need to ensure that schools have access to water and washrooms that ensure the girls’ privacy.

“Girls who do not  maintain proper menstrual hygiene risk contracting infections . Some of these girls  for example those in the northern Uganda just sit under the sun as away of containing periods.Even where we have given the girls pads, we find ways of ensuring that they have a water source and washrooms.” he said

Godfrey Walakira an official from Straight Talk Foundation notes that currently they are conducting a study in over 750 schools targeting 52,000 girls with an aim of understanding the impact of pads.

“The girls have been given reusable pads but even before the end of the study, preliminary results indicate that there is a great impact. So imagine if every girl could access these pads?

As partners we would also want to reach to every girl but we are limited by resources. We have proven it that reusable pads is a solution to menstrual hygiene, the government should pick a lesson or two from the various studies conducted.”he said

 Afripads were brought to the market to help many less privileged girls to stay in schools. Each pack contains three medium sized pads and another large one for the girls to use during the night.

Interestingly, this one pack can be used for over one year since each of the pads can be washed and dried just like what one does to the panties. 

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Ugandan diabetic children cryout for insulin

By Beatrice Nyangoma

Maganda Henry is admitted at Jinja Regional Referral hospital in ward four. He was diagnosed with diabetes type one, six years ago. When you looks at him, you may think that he is between the age of 12 and 15 years.

But Maganda is 21 years. His growth stunted because of diabetes. Everyday, he takes two injections of insulin-adrug used totreat diabetes.

His body also started itching especially at night and he would sweat alot. He says that he increasingly felt thirsty and water became his source of life. After several visits to the local clinics, he lost hope as he was losing weight everyday and yet the clinics could not find the illnesses. He was later admitted at Jinja hospital after being diagnosed with type one diabetes.

He says that staying in school to complete senior six has been a life time experience he will live to remember. Amidst financial challenges, Maganda’s care takers have to part daily testing – 12,000 Glucometer -20,000, Insulin-100,000 per month,Needles-50, 000 per month, Tablets-100,000 per month

This is in addition to 10,000 shillings to monitor his insulin levels from private clinics as his does not own Glucometer machine that costs about 200,000.

Maganda says that he does not wish any other child to experience what he has gone through. He appeals to government to avail insulin and injections and also reduce the price of glucometers.

According to Dr.Thereza Piloya Were, a paediatric Endocrinologist at Makerere School of Medicine with the number of diabetic children increasing over thd years, there is an urgent need for the government to provide insulin.

She notes that in the treatment centers funded by an international organisation Changing Diabetes in Children, Uganda has over 1000 children battling diabetes. The centers are located in the regional referral hospitals of  Mbale, Soroti and Gulu.  

She says that number is very small compared to the number of children who die undiagnosed. She also says that the cost of treating diabetes is very expensive and most families cannot afford it. She notes government needs to intervene and provide treatment.

Piloya describes diabetes as a group of diseases in which the body cannot handle blood sugar leading to its rise which destroys many of the body organs.The vulnerable body organs, he states include the liver, heart, reproductive organs and the placenta in the womb.

She notes children usually patients who are diabetic experience loss of weight, eat a lot, blurred vision, dizzy and low sexual power.

Globally, 415 million people were estimated to be leaving with diabetes in 2015 and this number is expected to increase to 640 million by 2040. In Uganda, the national NCDs study estimates the prevalence of diabetes at 1.3%. This translates to over 500,000 Ugandans living with diabetes.

Unfortunately about 80% of Ugandans living with Diabetes are not aware that they have it. These will present later with difficult to manage complications including blindness, kidney failure, stroke and even impotence. We must therefore up our awareness campaign efforts to prevent suffering and premature death.