Masindi Hospital fighting for life, in dire health  

AN air of decay and neglect hits you as you step into Masindi hospital. Its point of entry - the gate - is rusting away. It is partly caked in dust.

The two concrete pillars holding it in place are cracked. The chain link fence around the hospital is broken.

Barbed wires have been used to fix holes in the broken chain link fence with little success. There are still holes large enough for humans and animals to pass through. A first time visitor in the area may not easily tell it is a district hospital.

Several years ago, a giant signpost with words proclaiming Masindi Hospital, could be seen from a distance. Today, the words written in black on a white background are hardly visible on the same signpost from about 30 meters away. The white background has turned brown and the paint on the letters has been eroded.

But it is not just that! The road running from the gate through the hospital is littered with gaping potholes.

Mosquitoes breed in the stagnant water in the potholes. They bite patients and their attendants at night - infecting them with malaria - a major disease reported at the hospital.

Apparently, vehicles and motorcycles used to deliver patients are supposed to pull up outside the gate. Patients are expected to be placed on trolleys at the gate and wheeled into the hospital. But trolleys cannot move on the hospital's broken road network.

A bumpy ride into the hospital in a vehicle in a dangerous mechanical condition on a potholed path - about 200 meters - can worsen the condition of a patient before admission.

Pain
Last Friday, the engine of a motorcycle carrying a 20-year-old woman, in labour, and her husband, Godfrey Wabuke and her mother-in-law, Beatrice Nanjala, stalled twice on the potholed hospital path.

They were trying to avoid the impact of potholes on Christine - she grimaced and groaned - as the motorcycle moved at a snail's pace on the ragged path.

The three had travelled from Ntooma village, about 15km away, by motorcycle. Christine was tired and desperate for medical attention. She was helped off the motorcycle by her mother in law, but could not remain on her feet.

"I think the potholes have increased her pain and maybe deteriorated her condition. There were potholes from Ntooma to Masindi town, but the ones in the hospital are many and very big," Wabuke said.

But when Christine arrived, the maternity ward was temporarily closed as a doctor attended to mothers. Some moments after milling about the maternity ward, Christine was allowed into the (ward).

She walked through the maternity ward, passing several mothers lying in the beds, into the labour suite. The doctor in the ward had prevented anyone from entering the room, but a woman, in a high pitched voice, said, "Doctor, she is in labour."

But because the hospital suffers from a chronic inadequacy of medical supplies, Nanjala, who had entered the labour room with Christine, rushed out to tell her son, Wabuke, to go out of the hospital and buy a delivery plastic sheet and surgical gloves.

They arrived at the maternity ward with only a basin and some piece of clothes wrapped in a nylon sack. That was their mama kit! Mothers and their attendants sitting on a verandah outside the maternity ward gossip about the family for coming to the hospital unprepared.

"Some think they will buy mama kit items at the hospital. This is not a shop," a woman says. Wabuke, seemingly frightened, returned after a few minutes and handed the plastic sheet and a pair of surgical gloves to her mother.

"He has just brought one pair of gloves!" a woman exclaims, "I think he will keep going back to buy items,"

The district health officer, Dr. John Turyagaruka, says the facility discharges mothers prematurely to create space for others.

Indeed, some of the women sitting on the verandah have just been discharged upon giving birth. They have been asked to leave the maternity ward for new arrivals like Christine.

"I think a mother should spend 24 hours before being discharged after giving birth. But that does not happen here," Turyagaruka adds. If Christine does not suffer complications during delivery, she would be leaving the hospital within about 12 hours.

Crawling mothers
But Christine is probably lucky to have arrived at the hospital on Friday. If she had gone to the hospital on Thursday, she would not have probably been able to walk between beds in the maternity ward into the labour suite.

On that day, 24 beds, in a ward designed for ten beds, were all occupied. The corridor between beds was crammed with mothers lying on the floor, with some queuing up and crawling into the labour suite.  In the labour room, screened off from the maternity ward with a cloth being used as a curtain, nurses were involved in a frantic effort to deliver babies.

"I came here last night. I have been sleeping on the floor and now I am queuing up because I feel I am about to give birth. Beds are not enough and there is no waiting room for us," Clare Kabyanga, an expectant mother, says.

Behind her in the queue are four expectant mothers, including Scovia Katusabe, and Beatrice Amiriya, 28. Amiriya's attendant, Miriam Bagadira, 30, is lying on the floor with her six month-old baby and the expectant mother. Next to them is Maureen Tukamushaba, 20, who just gave birth. She is also lying on the floor with her baby.

Tukamushaba has been told to leave the hospital because the safety of the baby in this environment cannot be guaranteed.

The hospital has 13 midwives in the maternity ward, delivering an average of 15 babies in 24 hours, including about 10 C-section deliveries. "We discharge mothers before they get infections from lying on the floor with their babies," a nursing officer, Janet Agaba, says.

The hospital does not have facilities to enable pregnant mothers and their attendants to stay at the facility like a kitchen and a laundry room and washrooms.

The area behind the maternity ward is water logged. A mixture of blood and water from the labour room is deposited just outside maternity ward. This area is unkempt. Several species of weeds are thriving.

"I have washed clothes but I cannot put them out to dry because the area behind the maternity ward is bad. I stepped in pool of a mixture of blood and water," an attendant of a mother, says.

Since the maternity ward is not large enough, some women are sent to the female ward where they have to be attended to by general nurses, especially males.

Theater woes
As Christine was received in the labour suite, a mother, who had just given birth by C-section, was wheeled from the theater back to the maternity ward. The facility has only one theater equipped with a single operating table. Many times, medics have to make tough decisions on who to operate upon first. Some die as they wait to be wheeled to the theater.

"We try to convince others to wait and we handle emergencies first," Turyagaruka says.

What is known as Masindi Hospital today morphed from a few structures established by East Africa Railways and Harbours Company in the 1920s in Masindi town. About 100 years later, the theatre and maternity ward - the major facilities constructed by the company - have never been given a makeover.

According to Mahmood Kazimbiraine, the chairman of the hospital management committee, the facility was set up for transit passengers from DR Congo. These would live at Masindi Hotel, before leaving for Mombasa coast via Lake Kyoga. Masindi Hospital was also constructed by the same company.

"There were ship services on Lake Albert and Lake Kyoga. The company workers would travel from DR Congo to Mombasa using ship services on lakes Albert and Kyoga," Kazimbiraine explains.

When Turyagaruka was deployed to the hospital as a medical officer in 1986, the only facilities at the health installation then were; maternity ward, a theatre and a male ward - admitting men, women and children - and the Out Patient Department (OPD).

Between 1988 and 1989, Turyagaruka, who also served as medical superintendent at the hospital, says the population mobilized resources and started building a children's ward.

Desperation
The Government intervened and completed the children's ward in 1995.  Around 2000, the then district chairman, Nyakoojo Majara (RIP) secured funding from the British American Tobacco and set up a female ward - doubles as a gynecology facility.

Depressed, desperate and disturbed by the appalling shape of the hospital, the management committee has distributed funding proposals to various potential funders in a frantic effort to breathe life into the hospital - with a catchment area of over a million people.

Previously, its catchment areas covered Buliisa and Kiryandongo before the two districts were curved out of Masindi. Several decades ago, the hospital was thought to be serving about 50,000 people.

The 2014 population census showed that Masindi had almost 300,000 people. It indicated that the population had jumped from 129,682 in 1991 and 208,420 in 2002.

Inside the female ward, Firida Atuhairwe, a senior nursing officer, is mobbed by patients. She is wearing a plastic apron, with a white uniform under. The apron is stained with blood. This ward combines the medical, surgical and gynecology wards.

Our conversation with her is repeatedly broken by patients and their attendants; handing her drugs they have purchased in private clinics (not available in the hospital) for her to administer on the sick. Others tell her about the drip bags running out of water. It is a 40-bed ward, but numbers more than double sometimes, with some patients sleeping on the floor. The same situation plays out in the male and children's wards.

According to the hospital administrator, Simon Baguma, the facility has 41 nurses, 28 midwives, and six doctors. He says the hospital receives about 400 OPD patients daily, including an average of 80 at the Anti-Retroviral clinic. It receives sh178m under primary health care (PHC) and sh550m for drugs annually. Ideally, he explained the hospital should be receiving sh500m for PHC and sh900m for drugs. The number of nurses, midwives and doctors, Baguma says, ought to be doubled.

Majority of employees live outside the hospital due to inadequacy of accommodation facilities. 

The ministry of health permanent secretary, Dr. Diana Atwine, says currently there are no funds to rehabilitate the hospital, but adds that the health facility and others will be "worked on" when money is availed.

"It is not only Masindi that needs to be worked on. There is also Bugiri and Itojo hospitals but we do not even have money for that in the budget," she states.

However, the district chairman, Cosmas Byaruhanga, says Masindi Hospital is a special case; it is one of the oldest hospitals with obsolete infrastructure, has never benefited from an expansion programme, and is located in an area with growing population and increasing demand for health services partly due to oil and gas activities.

"The other new hospitals have been constructed with the latest technology. This is an outdated system," he adds. Byaruhanga explains that the hospital's theater and a maternity ward are makeshift structures and do not have requisite facilities.

"The theater has no room for preparing patients, no resuscitation room and no recovery area. It is just a room which was turned into a theater," he states," the same applies to the room which was turned into a maternity ward,"

Last Thursday night, a woman who had undergone an operation, was left on a trolley at the threshold of the door to the threater for some minutes (recovery) before she was wheeled back to the maternity ward.

"I am alone and I have to clean the theater and sterilize instruments before we get another patient into the theater," a nurse says. Medical instruments used in the entire hospital are sterilized in an electricity fired container -equal in size to a saucepan with capacity to hold five liters of water.

Byaruhanga says they asked the ministry of works to rehabilitate the roads, but they were told the ministry's network of (roads) does not include those inside a hospital. The municipal authorities, according to him, said the hospital roads are not under their care.

"But we have Kinyara sugar factory workers and tourists. The effects from oil are not going to be at the wells, but in areas like Masindi," the district chairman adds.

Recently, the central government was engaged to clear an electricity and water bill of about shh200m with the hospital being threatened with disconnection.     

Until money is found to rehabilitate the hospital, authorities may have to rely on PHC funds and seek donations and funding from sources outside Government to continue providing a semblance of health care