A few months ago, a driver of a trailer truck carrying heavy equipment to the oil exploration areas on the shores of Lake Albert lost control and plunged into the rift-valley. Several of the crew were seriously injured and needed immediate medical attention, but had to be airlifted upto Kampala.
and Fred Kayizii
A few months ago, a driver of a trailer truck carrying heavy equipment to the oil exploration areas on the shores of Lake Albert lost control and plunged into the rift-valley. Several of the crew were seriously injured and needed immediate medical attention.
Hardman Resource officials contemplated taking them to Hoima Regional Referral Hospital, but were told the hospital did not have proper medical facilities to take care of them. They had to airlift them to Kampala.
Hoima Hospital was constructed in 1910, during the colonial period, to serve Bunyoro Kingdom and the colonialists who had settled there. Though a few structures have been added over the years, the old ones have had little renovations.
In 1995, the hospital was elevated to a regional referral status. This meant it would also serve the entire Hoima district as well as districts of Masindi, Kibaale and Buliisa. Other hospitals in the region are district hospitals in Masindi and Kiryandongo and big health-centres in Kibale and Buliisa.
There are 11 regional referral hospitals in Uganda in Fort-Portal, Masaka, Lira, Soroti, Mbarara, Lacor, Arua, Kasese, Jinja and Mbale.
Hoima Hospital has, however, become a centre of pain, disappointment and frustration, as a result of lack of quality health services.
Only nine doctors
â€œI waited for days for a doctor to attend to me but none came. Instead, a harsh nurse attended to me. I later realised that some of the doctors at the hospital had their own clinics elsewhere,â€ says Suzan Bakikaho of Kigorobya in Hoima.
According to Dr. Emmanuel Moro, the medical superintendent, the hospital needs at least 35 doctors to operate basically. At the moment, it has only nine doctors.
â€œOf the the nine doctors, two are currently on study leave, meaning that only seven are at the hospital,â€ says Moro. Among the seven is Moro is one of the seven and is the only hospital surgeon. Three of the seven doctors are stationed at particular wards, leaving the hospital with only four doctors who can move around the wards treating patients.
â€œWe are supposed to have at least 10 consultants but we do not have any.
Of the required 70 paramedics, Hoima hospital has got only 30, while of the required 106 nurses, there are only 59.
â€œOverall, we have only 49% of the required medical staff at the hospital. Certainly, the gap is felt by our patients,â€ Moro says.
Moro denies knowledge of any of his doctors spending their time operating private clinics around Hoima Town. â€œIf it is happening, then I am not aware of it,â€ he says.
On average, the hospital receives 200 out-patients every day, in addition to 150 in-patients. This means that the four doctors have to take care of at least 350 patients every day! With a population of over 900,000 people in the four districts, the doctor-population ratio is 1:115,000 people. This is above the national average of 1:45,000 people.
â€œI was forced off a bed only two days after having a caesarean. I think it was a very inhuman thing to do because I was very weak,â€ Margaret Kayiise, says as she cradles her six month old baby. The baby has a bad cough. As she sits under the out-patients shelter, she is not even sure when a doctor will come along. Several other patients narrate the same stories of frustration.
The casualty unit has got one room. Although on record the hospital officially has 10 beds, there is no bed in the room.
â€œThis was a small district hospital that was constructed when the population of Uganda was just seven million. Since then, the population has grown four times more but the hospital is still the same,â€ Moro says.
In the maternity ward many women sleep on the floor. According to the hospital facilities directory, the maternity ward has one room, with 21 beds. One would expect that it would admit 21 patients, but this is not the case. At any one time, there are at least 50 women in the maternity ward.
â€œNormally, if a woman undergoes a caesarean section, she has to spend at least a week in the hospital. However, on many occasions, we realise that we have to remove these women off the beds sometimes only after three days so that we create space for others,â€ Moro says.
The childrenâ€™s ward, the menâ€™s ward and the surgery ward are all too small to accommodate the number of patients who are admitted every day.
According to the ministry of health regulations, all major construction work at hospitals is carried out by the ministry. â€œWe have put in proposals every year to the ministry for construction of more structures but we always get promises,â€ Moro says.
Being a Regional Referral Hospital, Hoima is supposed to admit the most complex of cases registered from the districts and should have modern equipment to handle such cases. On the ground, however, there is almost no equipment. The hospital has got some of the oldest equipment that has long been thrown out by small clinics.
Moro says the sterilisers are very old. They are often repaired, but even repairing them is expensive.
The hospital has no intensive care unit. This means that no patient on life support can be assisted at the hospital.
However, The New Vision has learnt that the lack of an intensive care unit is not only unique to Hoima Hospital, but to most of the other referral hospitals. Of the 11, only Mulago, Lacor and Mbarara teaching hospital, have intensive care units.
The hospital does not have incubators for premature babies to develop. â€œWe are improvising with insulators,â€ Moro says.
There is also no automatic respirator. This is the machine used to revive patients whose breathing is failing. The only new equipment at the hospital is a machine that helps monitor patients on anti-retrivirals that was got from South-Africa. The machine had a one-year warranty, during which time, specialists from South-Africa used to visit the hospital and check it. â€œBut since the warranty expired, these specialists no longer come. One of the elements of the machine that helps save power now has a problem because of the rampant power fluctuations. We are supposed to get these specialists from South-Africa but we do not have money for air-tickets,â€ Moro laments.
No blood bank
It is a prerequisite for all referral hospitals to have blood banks.
However, the referral hospital has none. A blood bank is a facility were blood is stored for emergency use. It is normally a room that is refrigerated 24 hours. â€œWe collect a lot of blood here, but we take it to Kampala because we do not have our own blood bank,â€ Moro says getting back this blood, whenever they need it is a problem. â€œOut of our total collections, we only get back a third of it,â€ he says.
Blood is very essential here because accidents are increasing by the day especially on the Hoima-Kiboga Road.
The hospital has a budget of sh405m per year, excluding the basic salaries of staff. Salaries account for sh1.6b, which money is disbursed differently. Moro says the hospital receives the least amount of money compared to all the other referral hospitals.
This money is allocated according to the population, but although Hoima has sent updates of the population growth, they have not received any additional amount of money. The sh405m is spent on specific projects, that have been agreed upon with the government. These include allowances that account for at least sh37.4m, fuel and lubricants sh34m, sh44m for civil maintenance, sh20m for maintenance of vehicles, sh45m for supply of goods and services, sh121m for medical and veterinary supplies, sh24m for electricity and sh13m for inland travel.
Moro says the drugs are there. â€œWe receive sh25m worth of drugs every after two months. The ministry directly pays this money to the National Medical Stores, so we just pick the drugs from there,â€ he says.
Some patients are, however, discontented with the way the drugs are administered. A resident in Hoima said that drugs are given out discriminatively.
Moro explains, â€œSome doctors make prescriptions of drugs that are not on the list of the Ministry of Health. As long as those drugs are not on the list, we do not have them here. That is why you hear patients complaining that they have been told to go and buy drugs elsewhere.â€
According to Bagonza Tinkamanyire, the Hoima district chairman, they are aware of the shortcomings at the hospital and they are lobbying seriously for improvements.
The hospital has a big piece of land on which new structures can be built and enough space for expansion of the hospital. The Ministry of Health is planning to renovate all regional referral hospitals starting in 2007. In Hoima, the project will start with the construction of a bigger maternity ward. â€œThis will reduce the crowding,â€ Moro says hopefully.
In trying to solve the power problem, the hospital has adopted solar energy for key facilities. These include the laboratories. AVSI, an Italian NGO, also donated generators to the hospital.
But as far as the equipment is concerned, Moro hopes the ministry will act fast and bring new equipment, otherwise according to another medical personnel at the hospital, they would rather not have patients!
Hoimaâ€™s sick hospital