Health centre IIIs a death trap

Sep 18, 2009

WHEREAS health minister Dr. Stephen Mallinga was surprised to find a health centre III in Mubende closed during working hours recently, a Saturday Vision survey has established that it is a normal occurrence countrywide.

WHEREAS health minister Dr. Stephen Mallinga was surprised to find a health centre III in Mubende closed during working hours recently, a Saturday Vision survey has established that it is a normal occurrence countrywide.

Surprise visits to randomly-selected health centre IIIs in various districts by a team of reporters established that most of them open only for a few hours, although they are supposed to operate 24 hours.

KABAROLE
At Kisomoro Health Centre III in Bunyangabo county, Kabarole district, a reporter arrived at 10:30am only to find the facility closed and without any staff.

Eighteen visibly-frustrated patients sat on the veranda waiting for the health workers. Some had been waiting since 7:00am.

At 10:00am, the patients narrated, a pregnant woman had come in with labour pains and on seeing the doors closed, the husband rushed her to the nearby private, non-profit Yerya clinic.

“The nurses are not here and my wife is in great pain. I don’t want to lose her and the baby. Let me rush her to Yerya, before her situation worsens,” the husband said.

“I cannot watch my wife die because I am waiting for health workers to come and help.”

The staff quarters, a stone’s throw away, had no health workers. People living next to the health centre said it usually opens after midday and closes at about 5:00pm.

The next stop was Rwimi Health Center III, which looked isolated. A sick-looking old man who was on the veranda, claimed nurses were sending away patients because there were no drugs.

The maternity unit was closed and had been turned into a cholera isolation ward when the dreaded disease hit the area a few weeks earlier.

The centre is supervised by a clinical officer and it has two nursing officers, two nursing assistants, one laboratory assistant, two porters and two askaris.

Mary Birungi, the nurse who was on duty, said the centre normally received between 100 and 200 patients daily but the number had reduced due to lack of drugs.

The lack of the recommended anti-malarial drugs had forced the centre to give patients fansidar, which has been blacklisted by the Ministry of Health because the malaria parasite is resistant to it.

Panadol was also out of stock.
“We are left with no alternative but to give patients fansidar and it is worse that we now don’t have common and simple drugs like Panadol Aspirin and others,” she said.

The centre has spent more than a year without a functional microscope, so even basic diagnostic tests cannot be done.
“The microscope broke down a year a go. we reported to the district health officer and the ministry of health but nothing has been done.”

The centre does not have any source of water other than rain, which they harvest and store in tanks. During the dry season, they buy water from the trading center at sh300 per 20litre jerrycan.

“I cannot waste my time going to a government health centre, when I know that there are no health workers or drugs. I would rather go to private clinics,” says Samuel Ateenyi, a farmer.

Kabarole’s director of health services, Dr Joe Oketch, said his department is working hard to improve the situation.

He warns that health workers who consistently absent themselves from work could lose their jobs. “We shall not tolerant health workers who are neglecting their duty while the Government is paying them.”

ARUA
Saturday Vision arrived at Riki health centre III, Oluko sub-county, Arua district at 10:41am. The benches in the waiting area were already filling with patients, some of whom said they had arrived as early as 8:00am.

The doors were open but there were no health workers. Asked where the health workers were, a patient pointed to the staff quarters.

Beyond the staff quarters, a woman was digging. She was a midwife. The patients said it was normal practice for health workers to tend their gardens before attending to patients, especially in the rainy season.

Between the outpatient unit and the staff quarters, our reporter bumped into the laboratory technician, Smith Okethwengu, who said he was new and therefore could not say much.

He added that the laboratory was under-utilised due to a perpetual shortage of reagents.

A month earlier, he had received a microscope from the district authorities but the machine had been lying idle because it did not have a reflector mirror. “I can’t tell how they displaced the reflector mirror,” he said.

The acting in-charge, George Adaku, said drug shortage was a problem.

On the day Saturday Vision visited the unit, there were only 2,000 tablets of Panadol and 4,000 of Septrin in stock for a population of over 20,000 people.

There were also 2,000 amoxylin capsules, 900 ciproflaxicin tablets, 6,000 aspirin and 5,000 mabendazole tablets.

Adaku blamed the shortages on the delay by the district to replenish their stocks.

Due to space shortage, the 45-year-old building, that once served as the outpatients section, has been converted into a one-stop in-patients ward, labour suite, post-natal unit and isolation ward.

It does not have a drainage system, so bloody water generated after a delivery is pushed out through the main entrance of the building.

The building is infested with bats and their droppings, which produce a nasty smell. Adaku stated that in the in-patients section, patients, many of whom sleep on the floor, are forced to vacate the room when it rains because the roof leaks.

The centre does not have an incinerator. Medical waste is dumped in a rubbish pit near a garden, where it is burnt in the open air.

Apart from the gas emissions being dangerous to the health of the people who live in surrounding areas, exposing the waste is risky, especially because children can easily access items like used syringes.

For a health centre that caters for five sub-counties to have just nine medical personnel is bad enough, but it is even more appalling that some don not show up for work.

Adaku assumed the post of acting in-charge because the clinical officer who was posted to head the unit in July has not moved to his new station.

“He has come here only three times and told us that he is still preparing to move here permanently,” he said.

Adaku explained that the unit had been allocated a clinical officer, three registered nurses, two enrolled nurses, one enrolled midwife, one lab assistant, one health assistant and one records officer. There are also two night watchmen.

But one of the registered nurses is away for studies, while the other two are not at station due to lack of accommodation.

They reside in Arua town, about 10m away, and often fail to go to work as was the case when Saturday Vision visited. One of the enrolled nurses, the health assistant and records officer were also absent.

Residents said because of the poor service at Riki, they preferred to go to Arua Hospital or a nearby Church-owned health centre.

According to Adaku, the health unit needs to be allocated transport for ferrying drugs and referring patients, if services are to improve.

He said the two motorcycles they had broken down and were parked at the district headquarters awaiting repair. The centre also lacked a solar panel for powering the fridge because it was stolen.

Adaku appealed to the central Government to construct separate general and maternity wards to reduce on the risk of spreading infections.

HOIMA
Workers at various health centres in Hoima district struggled to treat the increasing number of patients with out essential drugs.

Most patients said they preferred to go all the way to the main hospital in Hoima town.

Wilson Muganyizi, the clinical officer at Bugambe health centre III said it had only two trained health workers.
“The level of staffing is extremely worrying and the workload is overwhelming. The centre employs a clinical officer, a midwife and a records assistant.”

Muganyizi, who looked tired when Saturday Vision visited the centre in the afternoon, had a long queue of people waiting outside. “I have to attend to over 50 patients daily and this forces me to work till 6:00pm.”

He said some health workers had quit over poor working conditions, while others had enrolled for further studies.

Residents said the centre opens at 8:00am and closes at 6:00pm.
Muganyizi said the shortage of health workers was aggravated by the chronic lack of essential drugs.

He noted that the health centre had been running without basic drugs for two months, forcing some patients to go elsewhere.

“We have been without some essential drugs like Coartem for two months and we are told it’s out of stock in the district,” Muganyizi said.

“Those who have money go to private clinics where drugs are available. but most of our people are poor and have to wait until we get drugs.

“This is my first time to come here because I didn’t have money to travel to the main hospital. I don’t normally come to this health centre because it doesn’t have drugs or health workers” said Paul Kabagambe.

At Muhwiju health centre III in Buhimba sub-county, only one health worker was present when Saturday Vision arrived at 11:00am.

The health worker, Christine Birungi, complained of drug shortage. The laboratory does not function because there is no technician.

“Some times we don’t have drugs at all. We requisition for them but its takes a long time to get them. We only treat patients when we have drugs,” said Birungi.

“We have been giving quinine but it has also run out and we are only prescribing drugs for patients to buy from private clinics.”

Raymond Tumusabe, a p.4. pupil at Kikoboza primary school, said he has visited the health centre three times in one week hoping to get anti-malaria medication.

“I come here everyday for drugs but I don’t get them and they have now given me only drugs for headache. My parents have no money to treat me.”

KIBAALE
Bwikara health centre in Buyaga county, Kibaale district, was open at 11:10am.

Fourteen patients were waiting for the three out of eight health workers, who were present. There was not a single bed for admission. The centre had a brand new microscope which could not be used.

It had a maternity wing with an antenatal clinic that runs on Thursdays. The only water source was rain, which is collected in a tank at the maternity ward.

During the dry season, water is fetched from a shallow well 500m from the centre.

The health centre gets an average of 30 to 35 patients daily. The staff list has one clinical officer, two enrolled nurses, two nursing assistants, one midwife, one health assistant and two support staff.

The midwife, Mariam Babulya, is on a one-year study leave, according to Joseph Kwiratwire, a nurse who was on duty.

The health workers said they had not received primary healthcare (PHC) funds for more than half a year, which were to be used in the day-to-day running of the unit.

The money is for paying salaries of support staff and purchasing detergents used at the health centre.
At Mugarama health centre III in Buyanja county, there were no patients by 3:00pm, but the doors were open.

Five out of 11 health workers were present. There were no beds for admission and the centre did not have a functioning lab, although there is a brand new microscope which is kept in the store due to lack of a laboratory assistant.

It had a maternity unit which can accommodate at least four mothers at once. The unit has four rain water tanks but in the dry season, water is drawn from a shallow well a kilometre away.

The health centre receives 40 patients per day on average, but the number can go up to between 80 and 100 depending on the availability of drugs at the centre.

Out of 16 established staff positions, only six were filled, according to the in-charge, Albert Mukasa, a clinical officer.

The staff list had one clinical officer, enrolled midwife, four nursing assistants, one records assistant, one health assistant, two cleaners and a guard.

The health workers said the flow of PHC funds was irregular, making it difficult to plan and budget. So are the drugs. In stock was only 30 doses of Coartem and Septrin had been out of stock for four months.

Panadol was in plenty. The weighing scale, supplied only two weeks earlier, was not functional.

Teddy Kyaterekera, a resident of Mugarama, said the health workers had taken good care of her, although the drugs were in short supply. She said she often took her prescription to a drug shop.

The centre opens at about 8:30am and closes at 5:00pm.
Matia Mulumba, another resident, appealed to the Government to improve the health centre so that it can admit patients.

Compiled by:Abdulkarim Ssengendo, Ali Mambule, Frank Mugabi, Frederick Kiwanuka, George Bita, Hope Mafaranga, Ismael Kashoha, Luke Kagiri, Moses Nampala, Olandason Wanyama, Pascal Kwesige

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