Why seek treatment in Nairobi and not Mulago?

Kampala Lord Mayor Erias Lukwago recently returned from Nairobi Hospital. While Kawempe North MP-elect Mohammed Ssegirinya is still admitted at Aga Khan Hospital in Nairobi.

The Kabaka of Buganda, Ronald Muwenda Mutebi, has also been to Nairobi for medical treatment.

So has the Speaker of Parliament, Rebecca Kadaga and the outgoing Aruu County MP, Odonga Otto.

These are just a few of the many who have sought salvation from Nairobi, Kenya.

MPs, mayors, cultural leaders, ministers and other high-ranking officials seek medical treatment in high-end Kenyan private hospitals, such as Nairobi and Aga Khan hospitals.

The question is, why don’t they take advantage of the wonderful services at Mulago Hospital?

For one to go to Nairobi, you need over sh5m for booking.

EXPENDITURE

In August 2017, former health state minister Sarah Opendi indicated that the Government spends sh30b annually on sending ministers, MPs and senior government officials for treatment abroad.

The Auditor-General, in his December 2016 report to Parliament, said from 2014 to 2016, the Government spent at least sh10.1b on treatment of 140 top government officials abroad.

Aisha Nakiryowa, who is fundraising for her brother on social media to enable him to go to Aga Khan Hospital in Nairobi for a liver transplant, said doctors have advised that her brother has no chance in Uganda.

“We visited most of the big hospitals and we were told that there are no specialists to handle his case. So, we have to look for money to take him to Nairobi or India,” Nakiryowa says.

Christopher Omoding also had to take his sick father to Nairobi due to prostate cancer.

He said at the airport, he realised that many people were flying out for treatment.

WHY NAIROBI HOSPITALS?

Bosco Kasagga, the personal assistant to Ssegirinya, noted that they were referred to Nairobi Hospital by medics at Doctor’s Clinic in Sseguku on Kampala-Entebbe highway.

“When honourable came back from Kitalya Prison, he was complaining of stomach pain, he was passing stool with blood. We rushed him

Doctors wearing protective gear in an isolation ward of a hospital in Nairobi. This shows their preparedness to handle the COVID-19 pandemic

to Sseguku, where he was admitted. After several tests, doctors said the scan to see what was wrong in his stomach was only in Nairobi. So we had to get the evening flight to Nairobi,” Kasagga explains.

On admission at Nairobi Hospital, he said they paid sh5m as booking fees. Kasagga says he has never seen the care and professionalism exhibited at Nairobi Hospital, adding that that kind of care in Uganda comes at a cost.

“The hospital is old, like Mulago, but has well-maintained equipment. The facility is also clean, they have small ambulances within the hospital, meaning if the patient is expected to go to another ward for further investigations, they use these, instead of wheelchairs. In case the person has difficulty in breathing, the ambulance has life support machines,” Kasagga says.

He adds that the wheelchairs are also well-maintained and do not make noise when a patient is being moved around the hospital.

“Mulago is in a sorry state. Even when you are not sick, you go back home feeling ill because of the environment.

There are certain wards you cannot pass by without holding your nose. In Nairobi, it is like a hotel. You do not see blood everywhere, even at the casualty centre,” Kasagga says.

WHAT FORMER PATIENT SAYS

Amos Lugolobi, the Ntenjeru North MP, who has just returned from Nairobi Hospital, says he was referred there because doctors in Mulago said the hospital had no proper technology and personnel for his condition, yet he had COVID-19, which Mulago was treating.

“I did not go to Nairobi because I could afford; I was referred there. I was also surprised when I was told that our national referral hospital has no CT Scan and MRI machine, which I needed. They sent me to Nsambya Hospital in Kampala to carry out the scan and I had to pay for the ambulance. I was forced to leave the hospital because they did not have the technology needed. I also realised that there were no senior professors who have experience in medicine,” he says.

“Mulago should retain its senior doctors because experience counts. In Nairobi, it is senior doctors who see patients, not interns or young doctors. Nairobi Hospital has over three CT scans,” Lugolobi explains.

Lugolobi says Uganda prefers to give patients medicine from India, which is cheap and known to be of poor quality.

“In Kenya, they give medicines from Europe. When I got those drugs, I improved immediately. Here, it is also a problem of the National Drug Authority. The body that is responsible for checking the quality of drugs, is not on the ground. People sneak in fake or substandard drugs, which end up in our pharmacies,” Lugolobi says.

“So, when doctors recommend a drug, you might think you are swallowing the right one, yet it is fake. That is why people treat diseases for years,” he adds.

The legislator also notes that Mulago has nice facilities, but they are not organised like those at Nairobi Hospital.

“When I had COVID-19, I noted that the medics had limited personal protective equipment and that affected the patients because the doctors also feared for their lives. They could not just walk in and work on us without protection. In Nairobi, they use world-class technology for checking the lungs and the entire body. Mulago has space for equipment, but the equipment is not available,” Lugolobi explains.

He advises the Government to focus on improving the national referral hospital before concentrating on regional ones.

HEALTH OFFICIALS SPEAK OUT

Asked why Ugandans are abandoning their own hospital for Nairobi, Dr Joyce Moriku Kaducu, the state minister for primary healthcare, says it is mostly politicians, who are suspicious of the system, who are usually rushed out of the country.

“Most of those people are politicians who think they have been poisoned, yet their suspicions are imaginary. For others, it is usually on personal referrals, especially from relatives and friends,” Kaducu says.

Kaducu was also airlifted to Aga Khan University Hospital in Nairobi for treatment in 2017.

The minister also highlighted the delay in completion of Mulago as a major factor that could be pushing people to Nairobi.

She notes that plumbing is still going on at the new Mulago and that is why the casualty ward is still in the open. The only complete part is the women’s hospital.

“We held a meeting two weeks ago to discuss how soon we can get the casualty back to where it was and that is in the process,” she says.

“Although Mulago is still under construction, Ugandans should not leave their country because we have other regional hospitals, such as Kiruddu and Naguru, that can handle any complication,” Kaducu says.

The minister feels that the opening of Mulago shall help patients save on time lost being airlifted to Nairobi.

The refurbishment of the hospital, which kicked off in October 2014, was expected to last 24 months for normal services to resume in 2016.

However, completion has been postponed several times, owing to limited resources and other challenges.

The total cost of all Mulago renovations is about sh82.3b when you add funds from the Government and the Uganda Development Bank.

After spending all that money, why are Ugandans not seeking treatment at the hospital?

The health ministry permanent secretary, Dr Diana Atwine, says she is not bothered about the people who are leaving the country for treatment, because the silent majority are being treated here.

“They get healed and they appreciate the services they get from our major hospitals, she says. “Those leaving the country for treatment are people with money, they do not want to be seen treated in Ugandan hospitals. It is their choice. Besides, they even pay heavily. We cannot stop them, but what I know is that our doctors are doing great work in the region. We have operated complex heart issues at the Uganda Heart Institute,” Atwine explains.

She calls on Ugandans to have trust in the Ugandan health sector, saying the Government has invested a lot of time and resources in the health system.

WHAT OTHER DOCTORS SAY

A senior doctor, who works with Mulago Hospital, that spoke on condition of anonymity, said many people would not be rushing to Nairobi for treatment had the Government kept its promise of setting up a specialised high-tech hospital at Lubowa on Entebbe Road.

“We were told that Ugandans were going to stop donating money to other countries once that hospital starts, that the hospital was going to have specialised units, modern equipment and experienced doctors to handle any health complication. Where is it?

People have lost trust in our hospitals, For a long time, Mulago did not have a CT scan. Some of the kidney machines here are still down.

How can you allow to be treated in such a struggling health facility if you have money?” he asked.

The doctor, who is not happy with the way the health sector is being run, said government should prioritise health issues. He also called on the Government to inject more money in Mulago Hospital.

However, Dr Charles Olaro, the director of curative services at the ministry, says Mulago is capable.

He adds that if medical ethics allowed them to advertise what Mulago can do; many lives would be saved and prominent people would not have to leave the country for treatment.

Olaro says Mulago’s failure to advertise or market its services has affected it greatly.

“We can handle most of these cases referred to Nairobi. I think people just travel to Nairobi because it is out of the country. They do not want to be disturbed by relatives and friends, who are fond of storming hospitals when someone is sick,” Olaro says.

He also called on Ugandans to visit the different health facilities before travelling to Nairobi. “The only condition we cannot handle in Uganda right now is the kidney transplant. Otherwise, we are no longer referring people who have blocked vessels, because we can handle that here,” Olaro explains.

MULAGO HOSPITAL

Mulago Hospital is still the largest public hospital in Uganda. Founded in 1913 by Albert Cook at the present-day Old Mulago, the facility is the main national regional hospital for the entire country and a teaching hospital for Makerere University. According to the Ministry of Health, in the financial year 2014/15, the hospital attended to 829,817 outpatient visits; 761,573 inpatients, 61,568 emergencies and 28,759 total antenatal clinics visits.

There were 39,081 deliveries; 11,120 postnatal visits; 1,738,652 laboratory tests; 33,949 X-rays and 27,142 ultrasound scans.

The hospital did 49,680 immunisation contacts and 13,397 major surgeries.

In 2012, its annual hospital budget was sh33.2b.

In October 2014, major renovations and rehabilitation works commenced at the hospital, the purpose of which was to bring about structural and performance improvements.

These works, estimated to last 24 months, were the largest renovation works to the facility since the new Mulago Hospital block was completed 52 years ago.

When it finally opens to the public, the intensive care unit will be expanded from seven to 41 beds, the mortuary from 16 to 160 slots and operating theatres from seven to 22.

ABOUT NAIROBI HOSPITALS

The Aga Khan University Hospital, Nairobi, is considered the best hospital in East Africa.

Registered as a private, not-for-profit hospital, the hospital has been in operation for over 50 years.

According to its website, the hospital boasts of customer care, varied medical professionals with diverse expertise, modern medical equipment, evidence-based approach to medicine and cutting-edge research.

“The Aga Khan University Hospital has set the standard for comprehensive healthcare and modern medical education in East Africa. Our dedicated staff, advanced facilities and state-of-the-art technologies have earned the hospital great reputation as a leading medical institution and teaching hospital in the region, and beyond,” a statement on the website says.

According to Kenya’s department of health, the top three private hospitals in Kenya are Aga Khan University Hospital, Nairobi Hospital and M.P. Shah Hospital. Aga Khan also topped the most popular and well-regarded hospitals in Nairobi.

The best hospital rankings depend on the facility’s ability to handle life-threatening, difficult diagnosis or rare conditions and high-risk cases.

This is usually based on its speciality, skills and range of staff, experience, equipment and performance efficiency.

Kenya still ranks above Uganda in hospital quality.

According to Wikipedia, Kenya has 6,146 medical facilities for a population of 53,771,000, making it a facility per 874,894 people.

Uganda has 3,792 medical facilities for 45,741,000 people, meaning a facility for every 1,206,250 people.