Nakaseke Hospital: What is behind the health workers’ strike?

By Harriette Onyalla

HELL fury has erupted in Nakaseke Hospital. Not the whole hospital, but the gate. About 20 former members of staff demand to be let in. They want to strike. Of the 174 hospital staff, 28 have been transferred to health centres. These include clinical officers, nurses, nursing assistants, pharmacists, administrators and potters.

Nakaseke chief administrative officer (CAO), Andrew Kyamanywa, insists the transfers were aimed at improving health centres. “Victimisation, sexual harassment,” some transferred staff cry. But what is really happening? The cops are here. Their brief?

To ensure the hospital runs normally. The health workers and medical workers’ union leaders, refuse to retreat. They chant on.


Another group, the community, is watching. They must be shocked. After all, they regard their basawo (health workers) highly. Three quarters of the 7,000 patients come to this referral hospital every month from over 10km away.

Beatrice Nakayembe, a caretaker from Wobulenzi, about 17km away, says: “I am lucky I did not pay for drugs. I can now buy passion fruits for my daughter. Musawo says malaria ‘finished’ her blood.”

Nakayembe gave birth to four children at home until last year. She was rushed to Nakaseke Hospital with labour complications. ‘Bad’ reports make many women shun hospitals.

“I had to be operated immediately. They did it quickly to save my baby. We named her after musawo’s wife,” she says.
Finding patients who appreciate services at a government hospital in this country is like hunting for a hen’s teeth. But such is the praise for what these people now call “our” hospital.

Despite the aging walls with paint peeling off, the hospital is spotlessly clean. The old white beds in the wards are a little too close to accommodate more beds. Although the hospital has a capacity of 100 beds, admissions swing between 120 and 140 patients.

The nurses’ pink uniforms stand out like roses. Noiselessly they move, while a breeze from the forest blanketing the hill behind the hospital wafts in.

A doctor in a white coat passes; he smiles, nodding at the patients sitting on a bench in the outpatients department. A ‘very’ pregnant woman shifts in her seat as if preparing to kneel in greeting, but the doctor is gone. She shifts back, a smile pasted on her face as if she has been touched by an angel.

The other mothers start murmuring, everyone saying something; even the men who looked quite ill brighten up. It is as if the doctor’s smile cast a spell on them.

There seems to be a hushed precision about the way things run here. Like some unseen hand is setting the pace. There is a certain eagerness to help when the staff come across me ‘loitering’ in the corridors. Yet things are not as fluid as they look.

An October 31 directive by Ignatius Koomu Kiwanuka, the district chairman to Kyamanywa instructs: “The medical superintendent, Dr. Emmanuel Mukunya, be relieved of this duties.”

Koomu also directs for the suspension of the transfers of the 28 staff. Mukunya is accused of conniving with Kyamanywa to effect the transfers.
“My mandate stops at transferring staff from one ward to another,” Mukunya says.

A fortnight ago, Koomu wrote: “Remember our hospital has greatly improved under Dr Mukunya and his staff. We should not jeopardise that.”

He believes the transfers bear political undertones. “These civil servants are opposing me because I defeated their candidate during elections,” Koomu says.
Genesis

It began with a July 27 night meeting of a few hospital staff, who raised 14 complaints and forwarded them to Kyamanywa. The complaints included the delay of their June salary, doctors frequenting the maternity ward and mistreatment by some doctors.

On August 7, Kyamanywa wrote to Mukunya demanding an explanation and Mukunya replied on August 15.
Regrettably, in a country where maternal mortality is one of the highest in the world, with 505 mothers dying out of every 100,000 live births, these hospital workers complained that doctors frequent the maternity ward.

“This is justified. Health performance indicators target maternal disability and death as well as the outpatients department. Most emergencies come from the maternity ward. We cover maternity ward back to back and attend to other patients too,” he writes.

This team of six doctors knew that with four wards to cover, this was not going to be easy, but dared to try.
As for doctors being rude, he writes: “All doctors cannot have the same personality. This generalisation could discourage other doctors.”

The workers also complained that doctors leave nurses and midwives to monitor patients to which Mukunya replied: “The cardinal role of nurses and midwives is to provide nursing care.

If an independent investigation was previously instituted, you would find care to patients who had undergone surgery was poor.” He says improving nursing care was an uphill task, hence others took it as harassment.

The hospital improved, but Mukunya could have earned more enemies than he bargained for. “We try all ways to motivate staff. Fifty percent of the private wing collections go to staff motivation, 25% to purchase drugs, 18% for administration and 7% for minor repairs,” he says.

The Ministry of Health indicators show that Nakaseke Hospital has radically improved. However, Mukunya is accused of swindling money after a staff meeting decided that this money be deducted so they can buy a staff van.

By July, sh12m of the sh22m required was saved. Again, a July 11 meeting decided all the money be put aside so the van is bought by December.
“I am not responsible for that money.

Even mine is deducted,” Mukunya says.
As for the June 2007 salaries, Mukunya wrote: “I explained to my colleagues that the finance ministry released less money for the June salaries. Salaries go straight to everyone’s account. I was also not paid.”


Immunisation allowances also raised concern. The May and June allowances were not paid because the hospital’s outreach programmes were integrated, leading to more people participating. The allowances were, therefore, high,” he wrote.

The staff who attended the night meeting were also bitter that “the medical superintendent publicly informs people that they earn a salary.”

Mukunya says: “Making people know we earn salary ensures they are not illegally charged. It also empowers them to demand for services knowing we are not just doing them a favour.”
Sadly, some staff did not want to sleep in theatre at night.

Mukunya writes: “In all hospitals, theatre staff on night shift sleep in theatre. The theatre works 24 hours. Some staff thought this is harassment.

As stipulated in the health policy, this aims at curbing deaths in case of an emergency.”
“Some staff also preferred sleeping in places which are hard to trace in case of an emergency, yet there are duty rooms where they can be easily called upon.”

Sexual harassment
Monica Nakayovu, a midwife and nurses’ representative in the medical workers union says:
“It is not like that, he did not force anyone into a relationship.”

None of the 75 chits of issues raised during the staff meeting with Koomu contained a sexual harassment complaint. Dr. Badru Ssesimba, the district health officer, says he too has never received such a complaint.

Ssesimba says: “We had a meeting with the staff, but some of them were dodging work. The relationship between the medical superintendent and his staff seemed sour.”

It is, of course, understandable that discussing sexual harassment can be difficult. Mukunya says: “There was nothing like that until I told them that only sexual harassment and abuse of office could make me to be dismissed.”

Medical workers union
Workers MP, Dr Sam Lyomoki, is at the forefront of the nurses’ petition to the health minister and Parliament. He says: “I do not question Dr Mukunya’s competence as a doctor, but management skills. Nakaseke Hospital has 30% staffing. The mere fact that we, the workers’ union, got involved, means there is a problem.”

Theft
A man who stole a new sh3m microscope implicated some staff. A Police search of the staff quarters recovered hospital beds, blankets, bed sheets, drugs and other equipment.

Burying the dead
Joining the team burying unclaimed bodies rubs hospital askaris the wrong way.
“We have two mortuary attendants. Imagine two people carrying out a burial. Everyone deserves a decent burial. I also go and pray for those dead. Our appointment letters say, and any other duties assigned,” Mukunya says.

Mukunya
Over his head, poisoned arrows dash. This is probably the longest day in his 38-year life. Fade streaks his carefully-knotted deep blue tie. Energy in his handshake, a spark in his eyes, eyes which betray exhaustion.

“I am defending the medical profession. We carry names only for a short time,” he says.
Stacks of recovered medicines mob this modest office. A desk calendar with daily biblical readings stands on his crowded but neat desk.

Psalms 35 has been his favourite passage this past week. “Contend, O Lord, with those who contend with me,” the psalmist began.