Over 2,300 fake nurses work in Uganda

By Francis Kagolo

WHEN one-year-old Michael Mugwanya fell sick in December 2009, his parents took him to a nearby health facility.

Ironically, the boy ended up in more pain. The three injections the nurse, only identified as Nanyonga, gave him, turned the site septic and started swelling. Later, the skin began sagging and the flesh rot.

On the third day, the thighs and legs had also swollen and the boy’s health was getting worse. Barely a week later, the boy’s buttocks, back and stomach had gaping holes.

When his parents, Geoffrey Kibwami and Oliver Bukirwa of Nansana, Wakiso district, reported the case to Kawempe Police Station, the nurse was arrested and her clinic was later closed, after it was discovered she was not qualified to practice nursing.

When Dr. Kenya-Mugisha, then director of clinical services in the health ministry, studied the boy’s condition, he concluded that Mugwanya’s case was caused by undiluted quinine, administered by an untrained person, on a wrong site. “It is criminal to operate with no licence. You endanger people’s lives,” Mugisha said.

Although Good Samaritans saved Mugwanya’s life, other Ugandans are suffering at the hands of thousands of unqualified nurses.

Investigations conducted recently by the State House medicines and health services monitoring unit (MHSMU) revealed that over 2,300 fake nurses are operating in Uganda, out of 25,618, who are registered by the Uganda nurses and midwives council (UNMC).

“These (fake) nurses lack clear knowledge of diseases and the specific medicine to administer,” said Dr. Diana Atwine, the MHSMU director.

But even without such knowledge, they go ahead to administer the medicine, just to earn a living. In the process, people have died.

Atwine says the majority of fake nurses are products of illegal nursing schools. By October, the monitoring unit had discovered 60 illegal nursing schools across the country.

“These schools have existed unabated for long; they have no licences, no standard curriculum and their tutors are not qualified,” Dr. Atwine said during the just-concluded annual health sector performance review workshop.

To be admitted to a nursing school, candidates ought to have passed O’ level Biology, Chemistry, Mathematics, Physics and English. However, most students admitted to be illegal schools do not meet the criteria.

The investigations discovered some schools that conduct classes under trees. Others also lack training equipment and have poor infrastructure, yet their students are not attached to any hospital for practice.

For instance, for more than two years, Cirahs Uganda, Bugiri Nursing and Laboratory Training School, NESDA Uganda and Bulidha Vocational School in Bugiri district reportedly operated without qualified staff or proper toilet facilities until they were closed last month.

“Graduates of these illegal schools are running clinics with (forged) licences from Nkrumah Road. They administer injections wrongly and end up killing patients,” said John Wakida, the Uganda nurses’ council (UNMC) registrar. “You cannot go through an illegal school that has no equipment or qualified tutors and hope to provide quality services. We do not register or licence such nurses,” he added.

 Kampala worst hit

The congestion and tough economic times, have forced a vast majority of fake nurses to relocate to the city to operate illegal clinics, especially in slums.

For instance, a five-day impromptu inspection conducted by the health ministry in Rubaga and Kawempe divisions, discovered that of the 351 practitioners found in 100 clinics inspected, only 112 or 31% were genuine and registered with the relevant bodies. Only eight of the 100 clinics had valid operation licenses.

The inspection was conducted in March 2010 by the joint professional councils of the ministry.

“Many quack practitioners were found in the clinics,” the inspectors said in a report. “There were more unlicenced private clinics than the registered ones, which in most cases had expired operation licences.”

As a result, the inspectors recommended the closure of 53 of the clinics, which lacked qualified staff and suitable structures, because many doubled as bars. However, although the list of condemned clinics was not included in the final report, sources in the ministry said few were closed, while others were still operating.

Although Kampala is the worst hit, Wakida says the issue is a countrywide problem. In rural areas, fake nurses “hide” and run clinics deep in the villages.

This, Atwine says, has resulted into “unethical medical practice, injuries inflicted on patients, poor interpretation of government health policies, corruption and theft of drugs from public hospitals, as well as exploitation of workers by employers looking for cheap labour.”

But the problem is also attributed to the shortage of medical staff in the country, which has given quacks leeway to con the public. Data from the ministry of health shows Uganda is short of over 2,000 midwives and thousands of nurses.

Why illegal schools?

Wakida attributed the problem to corruption and the desire for quick money. Indeed, most of the institutions charge students between sh800,000 and sh1.5 m as tuition fees for each of the three terms in a year, far higher than what Makerere charges.

Nserester Complex in Masaka, which was closed was charging students sh500,000 per term, according to the district health officer, Dr. Stuart Musisi.

In Bugiri, Cirahs Uganda, Bugiri Nursing and Laboratory Training School, NESDA Uganda and Bulidha Vocational Training School charged slightly higher than sh500,000.

Wakida noted that the illegal nursing schools have had a dire effect on the quality of health services in Uganda. However, the ministry has embarked on a campaign to close them.

This year, the ministry has closed over 20 schools including four in Bugiri, two in Masaka and three in Ntungamo.

The Police and the Internal Security Organisation have joined UNMC and Atwine’s monitoring unit to hunt down quack practitioners.

But given the fact that they are thin on the ground, their effort is yet to yield tangible results. Thousands of quacks are still operating clinics in villages.

Who is to blame for all this mess?

Wakida puts the blame on the district education officers (DEOs) who allow peopel to start nursing schools, without following the due process.

“The situation used to be different, but starting from 1998, when the ministry of education took over training of nurses, things became political,” Wakida told Saturday Vision.

“DEOs would allow anyone who wanted to train nurses, irrespective of whether he had the required qualified staff, equipment and infrastructure to do so. The schools would even admit students who failed the essential subjects.”

Francis Ssekaddu, the former DEO of Masaka, said: “When the ministry of education took over responsibility of health institutions, we were not given clear guidelines to follow.”

“Apart from (temporarily) closing those which lacked essential infrastructure like latrines, we couldn’t do much! We kept on asking for the guidelines in vain,” he added.

However, the problem also lies at the heart of an unresolved conflict between the ministries of education, health and the nursing council over training and regulation of nurses and midwifery training institutions. The impasse has remained unresolved for over a decade.