Tag Archives: hospital

Broken bones and faulty machines

Michael, my husband, injured his hand about a month ago, and it was still hurting quite a bit, 4 weeks on. He was concerned that it wasn’t healing, and we wanted to get an x-ray to check that it wasn’t fractured and didn’t need a cast (something we were both dreading!! ).

Of course, there is nowhere to get an x-ray in Kamwenge.

So we begrudgingly piled into the car to set out on our fortnightly trip to Fort Portal, the nearest big town to Kamwenge. Fort Portal is a big town  (maybe 80,000 people? I really have no idea!) about 70 km’s away, and it normally takes about 1 to 1 and a half hours on a windy dirt road, surrounded by beautiful scenery – hills cultivated with maize, millet and matooke banana trees, a section of tropical rainforest with baboons along the way, and then rolling expanses of neatly ordered tea plantations, sprinkled with old houses left over from the colonial era. A beautiful drive.

But now that the wet season has well and truly come, the road is terrible. We crawled along for most of the journey, trying to avoid the gazillion pot holes and deep rivets in the road, all the time shaking our heads at the poor state of the roads. It took us over 2 very bumpy hours to reach Fort Portal for our day trip.

After getting all our other jobs done – recharging the internet modem, going to the bank, printing, getting stuff for MH ticked off the list – we looked around for a place to get an x-ray. First we tried a private clinic in town recommended by someone on the main street. We were told they are a clinic used by one of the main insurance companies in Uganda, and would definitely have an x-ray.

What I found was a small dingy room full of bored patients, with no staff in site. A woman who was waiting pointed towards the next room, where I found what looked like some makeshift outpatient rooms. It was only when I poked my head around the corner into a small store that I found a nurse. When I asked what I needed she was quick to tell me they had no equipment for x-ray here, but told me to try Kabarole Hospital – the Anglican church hospital round the corner.

Arriving at Kabarole, we struggled to find anyone to help us, just crumbling buildings and a freshly painted one labelled ‘private ward’. We approached the dispensary and after getting over his surprise that a white person would be there, the man shook his head as he told us the X-ray machine had been broken for some time. Instead, we should try another private clinic in town.

The next clinic wasn’t much different. Here, they were known for x-rays (it was even written on the sign outside) but unfortunately, the films were over and they didn’t know when they would next come. With a resigned sigh that conveyed almost no confidence, the women told us to try Buhinga.

Buhinga is the main regional referral hospital for this part of western Uganda. It is a government hospital. We have heard many stories of patients coming there to find doctors who will not see them without bribes, a lack of equipment and medications, and overcrowded rooms of very sick patients. Currently, this is where most people in Kamwenge get referred onto.

We were very lucky though. Or perhaps, more accurately, we were white. We found a nurse along the maze of undercover pathways that linked the hospital buildings, and she was friendly and happy to help us. She led us to the x-ray department, where we wove through dozens of patients sitting (or lying down), waiting for their x-ray or ultrasound. The doctor was pleasant and happy to do the x-ray for us immediately (and free), and although Michael’s hand was slightly fractured it was small and almost healed, so there was no need for a cast.

But as we were waiting for the film to develop, there was a little girl in line, needing to have her face x-rayed as she had a severe head injury. It was not possible. They were only stocking the half size x-ray films, which meant there was no way to get a full x-ray of her head. Her father, who looked poor and out of his depth in the situation, listened intensely as they told him he would have to take her somewhere else for an x-ray. I already knew from my experience that day that there were no other places in Fort Portal to get an x-ray and he would not be able to afford the transport to somewhere far.

Michael and I lived in Mannum a few years ago. In the small town of maybe 5000, they had a good x-ray machine. Compare this to Kamwenge, who in the town itself has about 20,000, but services a district of 350,000 people, with no x-ray machine.

It sounds clichéd but again it made me realise how lucky Australian’s are to have the health care system we have. As for me? I am not used to driving 2 hours on a muddy, potholed road just for a simple x-ray. I am not used to driving around to 4 different clinics in one big town just to find a working x-ray machine.

One day I hope and pray that this will be as strange to Ugandans as it is to me.

Bring your blade, bedding and basin…

A good friend of mine who lives in Kamwenge town is pregnant with her second baby. During the birth of her first child, her labour became obstructed. Because there was no place in Kamwenge that could help her, she travelled 1.5 hours on a dirt road, in severe trauma, on public transport to reach the nearest clinic that could operate on her. Her and her beautiful boy survived, although she now has a great fear of childbirth. Every time I see her, she fervently asks for me to pray for the safe arrival of her baby due in August.

But she was fortunate enough to be able to afford the cost of transport to Fort Portal, and was able to get there in time.

In Kamwenge, where the population has reached at least 350,000, there is no district hospital. The two main clinics in the district do not offer Emergency Obstetric Care. There is no working theatre. No running water or electricity. Many of the health staff are hardworking, compassionate individuals who are tired of having so few drugs and equipment.

Being a woman in Africa is tough. And one of the toughest things of all is giving birth. I read lately, in a journal article written by an anthropologist (I can’t remember the name of the article!), that in an area of eastern Uganda, childbirth is sometimes referred to in vanacular as ‘the trap’ because of the risks involved.

The maternal mortality rate in Uganda is 506/100,000 live births. In Kamwenge it is unknown, but expected to be much higher. Every year, 1.5 million African children are left  without a mother because she dies trying to give birth to a brother or sister. The risks in child birth are a struggle faced almost exclusively by poor women, with 99% of maternal mortality in developing countries. It is astounding in this era of medical advancement, that so many women continue losing their lives giving birth, and it is for this reason that Maranatha Health have chosen to focus on improving maternal mortality in Kamwenge.

Despite what I know, every now and then I wonder if what we are doing is worth it – maybe the situation in Uganda’s health care system isn’t ALL that bad.

Then, I read an opinion piece by Frederick Golooba-Mutebi in this weeks East African:

Maternal deaths: Why Ugandans are victims of their own civic incompetence

Recent media reports detailing the tragic deaths of expectant women and their unborn or newly-born babies in referral hospitals and health centres across the country have laid bare the crisis in Uganda’s healthcare system and made a laughing stock of the NRM government and its extravagant but empty claims about being focused on service delivery.

The anger, despair and disgust the many preventable deaths have caused are captured in the decision, reported in this column last week, by activists to take the matter into their hands and drag the Museveni government to court.

Reports from the “grassroots” indicate that in some cases relatives of the victims take matters into their own hands and threaten health personnel with violence. Others, however, behave as if their experience were the natural order of things and simply return home to bury their dead.

Before the decision of activists to enlist the law, only in a few isolated cases had victims of Uganda’s shambolic maternal health services sought to enlist the help of the police or courts of law. Two cases stand out.

One involved the death in early May of one Joyce Nabatanzi at Nakaseke Hospital, allegedly because nurses had been negligent. I have no idea how or where the story ended. However, a senior officer who claimed his staff were hardworking attributed the incident to the hospital having run out of essential drugs and supplies without which lifesaving surgery could not take place. Several phone calls to the National Medical Stores had not led to the desired response. To make matters worse, the hospital did not have an ambulance to transfer the patient.

The other was of a couple who lost a baby at Jinja hospital, also because of alleged negligence by nurses. The bereaved woman spoke for herself: “These people should improve. I heard countless insults from the nurses using obscene language. They handled me like I was a thief, pulling me from all sides.”

Unwilling to accept what had happened, her husband filed a case with the police. Here, as in Nakaseke, the hospital lacked drugs and supplies, as the father pointed out: “I bought everything since the hospital did not have the needed items to facilitate delivery.”

To add insult to injury, he could not get a post-mortem without coughing up more money: “Now someone tells me if I want a post-mortem, I have to give the pathologist transport.” According to a police officer on the scene, this was not the first time incidents of this kind were happening at the hospital.”

With all this in mind, it is difficult not to equate going to give birth at a public health facility in Uganda to going to war. As with combatants in war, here too, there is no way to tell whether one will come out alive.

There is, however, a sense in which combatants going off to war are better-off: They do not buy their own uniforms, guns, bullets, bombs, boots, or even food.

Meanwhile, expectant mothers going into government facilities must carry their own food, gloves, razor blades, sugar, tealeaves, bedding, basins and even saucepans. You have to see it to believe it. You would be forgiven for thinking they are moving house.

It is all too easy to buy into stories of the by now legendary negligence of health workers in Uganda. That is until you learn a thing or two about the conditions many face at work. Consider these statistics, which appeared in a recent newspaper report: Hoima hospital has 97 staff out of the 197 required. It requires 56 nurses but has only 34. It is run by eight doctors out of the required 35.

A brave nurse summed up how things work over there: “There is no other option than doing what we can and leaving what we can’t. What do we do when things are beyond our reach?”