By Gilbert Kidimu

IMAGINE saving 99 lives and consequently losing your own. It is ironic, yet a reality for many health workers in Uganda. Like soldiers on the frontline, health workers risk their lives amid outbreaks of highly contagious diseases including Hepatitis B, H1N1 virus and ebola.

Among the most memorable is the late Dr. Matthew Lukwiya who contracted ebola as he attended to patients in Gulu district in 2000. A number of medical workers, including Dr. John Kule, succumbed to the disease as they tended to patients in Bundibugyo in 2007.

“Nine years ago, ebola was new to Ugandans, so medical practitioners did not know which precautionary measures to take while attending to patients.

Some consequently became victims of the disease,” says Dr. Isaac Alidria, a medical surgeon at Mulago Hospital.
Another doctor says he has treated three doctors and five nurses suffering from tuberculosis, which they contracted from patients.

Surgeons are more prone to highly contagious diseases such as tuberculosis because they get in contact with a patient’s body fluids.

In the outpatient department, emergency cases are received without prior diagnosis. Maria Twinamasiko, a nurse, says: “Our lives are endangered because we wouldn’t know the disease a patient is suffering from.”

Standing for long hours
This can be detrimental to the lower back. Surgeons, especially, stand for hours as they operate on patients. “It is advisable to go for physiotherapy or a massage after long hours of standing, but only a few take the trouble since it isn’t a prerequisite,” Tumwebaza says.

Expectant doctors
Expectant doctors work like anybody else. The include doing ward rounds, which take about two hours, and this involves a lot of standing.

At many public hospitals, pregnant doctors, (who are supposed to keep away from hygienically compromised environments) work till they are almost due and go on maternity leave. “The time spent in such an environment is enough to expose them to infections,” Tumwebaza says.

The glove will protect them from direct contact, but what about the prick of a needle? Some midwives have reportedly contracted HIV/AIDS while attending to women in labour.

Unlike some professions where workers are compensated, medical practitioners in public service are not. In case of an accident and where loses his life while on duty, his children do not get benefits.

Safety measures
In medical school, there is hardly any formal training emphasising medical practitioners’ safety. However, emphasis is placed on patients’ safety.

A doctor who prefers anonymity says sometimes, consumables run out in busy facilities like public hospitals, so health workers are forced to attend to women in labour without protective gear. Such exposes the mother and midwife to infection.

When some hospitals run out of labour equipment, medical workers ask expectant mothers to carry gloves. Nonetheless, guidelines have been enforced to reduce risks. These include vaccination and wearing protective gear in aerated wards.

“The health ministry has vaccinated most of the people working in such environments,” says Dr. Isaac Ezati, the deputy executive director of Mulago.

Long surgeries for example separating siamese twins and heart surgery, which might take over eight hours, are supposed to be carried out in shifts.

Ezati says in the labour ward, one should not get in contact with body fluids without wearing gloves.
In case a medical worker is infected accidentally, one should get post exposure prophylaxis, where a victim is given anti retroviral drugs (ARVs) immediately, to prevent the infection. The medication, however, only works within 24 hours.

Nsambya Hospital provides free ARVs to a medical worker who has been exposed to HIV while at work. “ARVs should be part of the emergency box, especially in theatres so that in case of an accident, prevention is done within the required time,” Tumwebaza says.

Some health workers, especially nurses in rural areas, should receive formal training on how certain diseases are transmitted and how to protect themselves.

Alidri says it is prudent to look at where a patient has been in case they could be coming from a country where an outbreak of a contagious disease was reported.

Tumwebaza says when dealing with highly infectious diseases, there is barrier nursing, where a patient is put in a separate room and the air getting out cannot be used elsewhere.

“The room is ventilated and UV lights, which are believed to sterilise germs, are used as well as air conditioners. The patient and health workers wear protective gear,” Tumwebaza explains.
Hand washing is the leading precautionary measure against infection.

Tumwebaza says wards should always have water and salt, germ blisters and immunisation against preventable diseases. However, the medical field involves inevitable risks.

Alidri says it is the pledge they made as a doctors — to save lives, no matter the circumstance. “In case there is an HIV/AIDS patient; as a doctor, it is would be unethical for me to leave the patient because I am afraid of infection. It is part of my life no matter the risks involved,” Alidri says.

What Medical workers say about their work
Justin Nakiyingi, a nurse, says: “I wear gloves and a mask, although sometimes patients expose us to infection. For instance some patients fidget as they are being injected.

“But exposure to tiny infections gives us a certain degree of immunity. I am not afraid of infection because the medical field has such challenges. I am trained to expect that. Once I get an infection I treat it.”

Sera Nankya, a nurse, says: “There is an isolation room for such patients. When attending to patients, we cover the mouth and nose. And while handling patients living with HIV, one has to wear gloves for protection.

“However, I am not afraid of treating patients because the medical field has such challenges.”

“We are trained to save lives and we do it so religiously that we sometimes forget to save our own lives.”
“We were trained to save others, but our lives. It is a common weakness among health workers not to take their safety seriously as they attend to patients,” says an anonymous source.

“It is a tough experience, especially during epidemics like the swine flu. When you receive a patient before diagnosis, you do not know what they are suffering from. When it is an emergency, we receive patients without wearing protective gear.

“If someone has shown signs of having a disease, we wear protective gear,” says Mary Owoko, a medical worker.

Margaret Akello, a midwife, says sometimes midwives are not immunised yet they attend to expectant mothers with infectious diseases. “You cannot be certain if an expectant mother tested for HIV/AIDS.”