Access to and delivery of health services at Kitagata General Hospital continues to be a challenge for patients and health workers, 48 years after it was established. Shortages of medicines and key staff, dilapidated structures and power failure top the list of challenges that bedevil the hospital that was once the pride of the Greater Bushenyi area. It is located in Muhito parish of Kitagata Sub County in Sheema, one of the four new districts created after the split of Bushenyi.
Shortages of medicines and key staff, dilapidated structures and power failure top the list of challenges that bedevil the hospital that was once the pride of the Greater Bushenyi area. It is located in Muhito parish of Kitagata Sub County in Sheema, one of the four new districts created after the split of Bushenyi.
A URN reporter visited Kitagata this week and now tells the story.
As I arrive at the facility, several signposts litter the gate that welcomes me to the biggest health facility in the greater Bushenyi area. The sign posts are rusty and layers of algae are slowly but steadily forming on them.
This requires me to take a closer look at them to be able to read what is exactly written on them.
Next to the gate are small temporary canteens selling various commodities such as tea, porridge, Bananas, and basins among others.
Kitagata whose bed capacity is 100 receives patients from the districts of Sheema, Buhweju, Rubirizi, Bushenyi, Mitooma, Ntungamo and Rukungiri. As a result the number of inpatients has doubled to 200 and on average the hospital receives 500 daily.
The huge numbers of patients received exert pressure on the facilities at the hospital. The hospital, despite being one of those recently renovated by the government, is yet to get back on its feet.
Inside the gate dozens of patients compete for space at the waiting room of what happens to be the outpatient department where nurses try to attend to them. The noticeboard in the same structure tells a lot about the hurdles that the facility has been going through for the better part of 2017.
An internal memo dated October 15, 2017 indicates that laboratory services had been suspended due to power interruptions. The same memo indicates that the facility was trying to secure a backup generator or just proceed with the collection of samples and have them worked on when power stabilises.
Stock-outs of drugs and other vital supplies are also common at the facility. Several memos hanged on the noticeboard explain this. A memo dated May 26, 2017 indicates that the hospital had run out of stock for 36 essential drugs.
On November 9, 2017, the hospital management also announced the stock-out of kits used for testing HIV prompting the facility to suspend the services.
Having spent close to two hours moving up and down in the outpatient department and disguising as patient, I'm approached by one suspicious health worker in uniform without a name-tag who declines to reveal her identities. But she is concerned as to why I'm not joining the queue.
I tell her that I had escorted my expectant wife for antenatal clinic and she leaves me with a smile on her face. She actually tells me that they give the first priority to women who go to the facility escorted by their spouses as a way of encouraging men to always escort their wives for antenatal care.
Empty and Abandoned offices
The structure next to the out-patient department is a big one and hosts the Grade A section where locals are required to pay for the services received. The numbers there clearly indicate that only those who can afford to pay access the area.
The numbers are visibly much fewer than those at the out-patient department where the services are supposed to be free.
The same structure hosts the Administration Block. The office of the Senior Nursing Officer and that of the Medical Superintendent are under lock and key and the dust in corridor and on the door-handles indicates that they have not been opened for days, if not weeks.
I finally managed to enter the office of the hospital Administrator, Felix Muhanguzi, but he is not in. A clean table with a white cloth on top, a lap top computer and some papers are scattered on the table.
It is about 10 minutes to midday and moments later a health worker and most likely of the lower cadres joins me in the office. After introducing myself as a journalist, she says that her boss was having tea in another room nearby. About 10 minutes later, a slender dark-skinned man arrives and he happens to be the owner of the office where am seated.
The administrator is a cool and flexible person who grants me a chance to share with him for some minutes and also accepts to take me around the hospital despite making an unannounced visit to the facility.
From his office we head directly to the X-ray room.
I learn that the machine delivered to the facility two years ago had to lie idle for over a year. Muhanguzi claims that the hospital could not get space to host it since most of the structures were under repair.
The X-ray room is abandoned and Gerevase Tumwesigye, the Radiographer, is nowhere to be seen. A gentleman attending to the sterilizer tells me that Tumwesigye had just moved out.
A dusty but visibly new delivery bed is abandoned in the corridor leading to the X-ray room and on inquiry they told me that it is just there and will be taken back to where it is supposed to be.
At the Maternity ward
The maternity ward is very congested prompting the administration to add more beds.
Space that is meant to accommodate two beds has an extra bed added and some opt for 'floor cases' as the health workers describe it, referring to patients sleeping on the floor. Indeed, mattresses are spread on the floor between beds taking up spaces that should have been left open to ease movement.
About four health workers are attending to the expectant mothers in the wide ward.
The Emergency Unit
The facility does not only lack the structure to host the emergency unit but also lacks the equipment. The unit is supposed to provide initial treatment for a broad spectrum of illnesses and injuries, some of which may be life-threatening and require immediate attention.
The unit is supposed to work 24 hours a day. It is supposed to have a Resuscitating Machine among other vital equipment. The absence of a Resuscitating Machine means that the facility cannot attend to patients in coma especially those with cardiac arrests. Patients with such difficulties are instead referred to Mbarara Hospital, some 62 kilometres away.
Also missing at Kitagata Hospital is a Ward for isolating patients with contagious diseases and as a result, patients of different illnesses are mixed up.
The hospital administrator admits the fact that they have no option and have been mixing Tuberculosis (TB) patients with others despite the danger that they may pose to other patients.
The facility used to be the only health unit in the greater Bushenyi with an incinerator. The incinerator is no more.
Green Label Services Ltd (GLSL) is an environmental and public health consultancy firm which carries out safe disposal of hazardous waste. The firm however picks the waste twice a month, an indication that the hazardous medical waste has to be kept for at least two to three weeks.
The medical waste has serious consequences on human beings and the environment if not well disposed of. Incorrect disposal can lead to infections as it can contaminate the environment and water sources.
The facility survives on one Land Cruiser ambulance to attend to emergencies. At times attendants are asked to arrange transport means for their patients in case of emergencies or need to have the patients urgently referred.
Keneth Rutaaki is a boda boda cyclist at Kitagata trading centre just a kilometre away from the facility. He says that the locals in the area have now mastered the art of surviving at the facility.
Rutaaki says that giving out money to the health workers works best since you are attended to first while those who cannot afford to pay are made to wait or at times advised to come back the next day.
Back at the hospital, Moreen Twikirize is attending to her sister in-law at the facility and also delivered from the same hospital. Twikirize, 28, says that health workers at the facility demand for money from patients and their attendants so that they can be attended to on time.
She says that some locals stay away for fear of being charged at the facility whose services are supposed to be entirely free, save for those opting for the grade A section.
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The allegations by Twikirize are re-echoed by other patients who do not want to be on record.
The documents on the notice board at the out-patient department also indicate that the concern has been in place for a while as the top facility's administration is asking patients and their attendants not to pay money to health workers since the services are free.
A staff member at the maternity ward acknowledges that she has on some occasions seen her workmates asking for money from patients or their attendants. She admits receiving money from patients herself but claims that they would give out the money willingly in appreciation of her services.
Felix Muhanguzi, the administrator says that the hospital is trying its best despite a series of challenges.
Muhanguzi says that the facility struggled with drug stock-outs on several occasions during the year 2017 and that some staff such as an ophthalmologist are not in place.
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He says that this has affected their relationship with the community.
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On the issue of handling emergencies, Muhanguzi says that the facility is in a tricky situation since there are no structures, no equipment and mixing of patients remains the only option.
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Muhanguzi further reveals that inadequate staff accommodation and absence of a functional incinerator are among other challenges faced by the facility.
On the allegations of extortion by the health workers, Muhanguzi neither admits nor denies, saying that the patients and their attendants are in a better position to tell.