One doctor serves 300,000 patients in Kapchorwa Hospital

By Frederick Womakuyu

THIRTY-year-old Charles Chemonges went to Kapchorwa Hospital complaining of body pain after a serious brawl in a bar.

He needed an X-ray scan and Computerised Tomography (CT) scan of his entire body, but Kapchorwa Hospital could not offer the services. He was referred to Mbale.

However, a few minutes after Dr. Martin Erieza, the head of Kapchorwa Hospital had left, Chemonges passed away because he could not get an Xray at the hospital.

STAFF SHORTAGE

The health sector in Kapchorwa district faces dire staffi ng and equipment shortages. Dr. Rogers Masaba, the district health offi cer, says only 49% of the health staff positions are fi lled, compared to the national average of 51%.

Kapchorwa Hospital is a general health facility serving a population of over 300,000 people within Kapchorwa and the neigbouring districts of Bukwo, Sironko and Bukedea. Others come from Karamoja and the western parts of Kenya such as Kapenguria.

While the health ministry requires the hospital to have about seven doctors, Kapchorwa Hospital has only one doctor, who serves as a clinician and the hospital superintendent. Masaba says none of the 25 health centres have a doctor.

Kapchorwa Hospital also lacks many specialists, including a pharmacist, radiographer and an optician. It has to rely on its lone doctor for everything.

However, his skills are limited and he cannot handle everything. So, he refers many cases to Mbale Hospital.

Erieza says theatres in health centre IIIs do not operate due to lack of doctors and mothers have to walk long distances of over 40km to the hospital for delivery.

He receives about 11 caesarian section cases per week, yet at times he is not around. This has increased the infant and maternal mortality rate, which stands at 12 and nine deaths annually respectively, according to the 2008 Kapchorwa Hospital statistics.

“I cannot do everything at the same time. I have to be in the operation theatre, the maternity ward and also do so many other operations. I am alone and sometimes I feel I am wasting my time here. We need more doctors,” Erieza explains.

Masaba says while the World Health Organisation recommends that one midwife should serve over 90 patients, in Kapchorwa one serves over 5,000 people.

The hospital ambulance is grounded

He says Kapchorwa Hospital is sup posed to have about 25 midwives, but they have only 10. All health centre IIs are supposed to have at least one midwife each, but only one of Kapchorwa’s 20 health centre

IIs has a midwife, health centre IIIs are supposed to have two midwives, but all Kapchorwa’s health centre IIIs, except one, have one midwife. “With these disparities, how do you expect us to deliver maternal health?” Masaba asks.

Grace Cheptegei, a midwife at the hospital, says they have only two delivery beds, yet they perform over 35 deliveries per week and the delivery room is small.

Masaba adds that health workers are shunning the district due to lack of accommodation and poor remuneration.

He says while a doctor employed by a non-governmental organization earns an average of sh3m per month, a government doctor earns about sh600,000 per month. “This cannot boost their morale,” he says.

“Kapchorwa district has established an allowance of sh500,000 for doctors, but we still cannot attract and retain any due to lack of accommodation and difficult terrain. Kapchorwa is hilly, with very few good roads, so peoplefear to work here,” he adds.

David Sorowon, an enrolled nurse in the children’s ward, says they receive over 70 cases of children suffering from pneumonia, malaria and malnutrition per day.

However, there are only seven nurses in their ward who work for 24 hours and are always tired as a result.

“We have no time to do other things. Some of us are serving the hospital voluntarily because they have never formally recruited us,” says Sorowon.

He adds that he has been serving the hospital since 2007 without any appointment letter or salary.

Erieza says some staff are operating without appointment letters because the district was operating for a long time without a district service commission to recruit staff.

EQUIPMENT AVAILABILITY

Erieza says they receive over 100 patients per day requiring X-ray and CT scans, but because they do not have the service, they refer the patients to Mbale district.

They do not have an X-ray department because the hospital was supposed to be built in three phases, but only one phase was completed and some wards and departments are missing.

Two departments that are vital to any hospital are the laboratory and the pharmacy.

However, at Kapchorwa Hospital, these were not built. The hospital administration has partitioned the outpatients department to accommodate the laboratory and the pharmacy.

This has brought about congestion in the outpatients section. There is also no consultation room and health workers have no room to sit in. Masaba says the situation is worse for the lower health centres. He says health centre IIIs and health centre IIs have only out-patient departments, but do not have wards. He adds that these health facilities lack essential instruments like syringes and delivery kits.

In the children’s ward, an oxygen concentrator is vital for children that face difficulty in breathing, but the ward in the hospital does not have one, which has led to the loss of lives.

The entire hospital has only two oxygen concentrators that serve all the wards.

Erieza notes that they need about 10 oxygen contractors to operate effectively.

Although the hospital receives eight to 10 cases of children with severe malnutrition per week, worsened by the increasing cases of HIV infection, they have no nutrition unit. Chelimo says consequently, they lose over three children to malnutrition per month.

The hospital also receives about 10 to 12 mental cases per day, but does not have a psychiatrist expert or a department to deal with such cases. Lucy Kaphebasa, a psychiatric clinical offi cer, who is a diploma holder, says she has limited counseling skills.

She adds that the situation is compounded by the shortage of essential drugs. Kaphebasa explains that the hospital has not had Haloperidol tablets for about three months.

POOR FUNDING

Dr. Rogers Masaba says for the last six years, the health ministry budget for the district has been only sh184m. The district retains 10% of this money for its activities, including running the district o­ffice and the 90% goes to the 25 health centres.

He says Kapchorwa Hospital receives only sh256m, which is used for paying support staff , rehabilitating and maintaining the hospital, buying fuel and repairing vehicles.

“The money is hardly enough and we are stranded,” Masaba says. Some vehicles bought in the 1990s have broken down and they currently have no vehicle.

“There is only one ambulance operating within a very short distance,” Masaba says.

“The National Medical Stores brought some drugs and we could not supply them to the health centres because we had no transport. In addition, there is always drug shortage,” he says.

Erieza requests donor partners to support the hospital with vehicles so that they can move to lower health facilities to deliver services.