Is Mulago hospital turning into a healthcare symbol in peril?

Mulago national referral hospital has, for as long as we can remember, been the healthcare refuge for ordinary Ugandans, at least to the extent that it’s relatively cheaper compared to private hospitals in the country.

However, the facility now stands as a stark indication of a collapsing public health system, writes NATHAN ATILUK. When Justice Irene Mulyagonja lost her husband, John Baptist Kakooza, over a month ago, she narrated her Mulago ordeal while taking care of the late Kakooza, citing lack of basic health care materials even in the private wing.

Mulyagonja worried for those who cannot afford the private wing, saying, “if basic items like oxygen can be unavailable in the private wing, then what could happen to the ordinary sections?”

At the casualty wing of the hospital, where patients with life-threatening conditions such as accidents are received, one is welcomed with the overcrowded rooms, already sending signals of the kind of treatment that awaits them. Established in the 1960s, Mulago was designed to accommodate 1,600 beds.

However, the hospital often serves more than double its capacity on a daily basis. If you ever heard of sickening claims that some patients lay down on the cold floor of the wards, with no hospital beds to rest on, you need to visit the hospital for a firsthand experience.

At this national referral hospital, this has become a normal practice. Because of the overwhelming numbers, patients, especially in the common wards, often find it extremely hard to access attention from a physician or nurse on duty to attend to them regularly.

Joseph Bizimungu, a victim of a boda boda accident, narrated his plight to us, saying he had been admitted three days before we met him, but his carer has to struggle a lot to grab the attention of a doctor.

“Sometimes I have to literally beg and follow the doctors around just to get them to attend to my brother’s excruciating pain. The other challenge we face is that we are never sure of whether or not we shall have a bed every now and then because at one time you have it, and before you know it, it’s being taken away from your patient,” said Asiimwe Bizimungu’s sister.

People presume Mulago to be a free public hospital accessible to all. However, for most patients, nothing is truly free. Medicines, surgical gloves, cannulas, oxygen and even sutures are often out of stock, forcing desperate families to buy these items from private pharmacies at exorbitant prices, which resultantly erases the fantasy that Mulago is largely free of charge.

Patients scheduled for operations are frequently turned away due to the unavailability of essential surgical supplies. In some wards, relatives are seen running from pharmacy to pharmacy, clutching prescriptions that include basic antibiotics or painkillers.

“Sometimes, even accessing services as basic as blood tests or even X-rays can be a serious challenge here. For those who can afford the Shs 150,000 for a CT scan, the challenge still comes when your patient has to endure pain, waiting in a long line of several other patients to be worked on,” Saidi Kamoga, a patient, narrated.

One of the hospital’s most critical issues is human resource overload. On any given day, a single doctor may be responsible for more than 70 patients. A junior physician at the hospital (names withheld) revealed that part of the challenge faced at Mulago stems from the available human resources being overstretched, with some wards operating on ratios as high as one nurse per 30 to 40 patients.

“This is wild,” he said. Mulago’s woes don’t stop at the patients and healthcare providers; the carers, too, have their own share of the agony. Away from sleeping on ice-cold verandas, they also narrate the inconvenience that comes with being forced out of the wards several times a day, leaving their patients helpless for a long time.

“Most times we are not even notified before being chased out of the wards, only to be rushed out of the wards for long hours. This wouldn’t be a problem, but by the time you return to your patient, some of your property and items are either missing or misplaced, and you have to buy more again, which makes everything more stressful and more expensive,” revealed Joyce Nabweteme – a carer.

WHAT SHOULD BE DONE?

Despite its challenges, Mulago has had glimmers of progress. In 2023, they performed Uganda’s first successful kidney transplant and secured funding for specialised care through the ministry of Health.

The government also received an $88 million loan from the African Development Bank for hospital renovation and modernisation. However, critics argue that while infrastructure is slowly improving, the core problems remain untouched.

Budget shortfalls continue to cripple services. Mismanagement, poor procurement processes and corruption have led to the diversion or waste of critical resources. Health sector observers argue that money alone will not save Mulago, suggesting a complete overhaul of hospital governance, improved supply chain systems, fair remuneration for staff, and increased accountability from management to parliament.

atiluknathan@gmail.com