Tabu Butagira, Hussein Bogere & Joseph Mugisa
7 December 2007
Bundibgyo/Kampala — THE Uganda Medical Workers Union, an umbrella association of about 20, 000 health workers has asked under-resourced and unprotected medics attending to Ebola patients in the worst hit western district of Bundibugyo to leave immediately.
"All (health) workers who are not provided with protective gear should not work on suspected Ebola cases and (should) leave straight away," the Union chairman Dr Apollo Nyangasi said yesterday.
The recall comes a day after Dr Jonah Kule, a medical officer at Bundibugyo Hospital, his junior Joshua Kule, a senior clinical officer, Ms Rose Bulimpikya, a matron at the same hospital and another unnamed nurse, who all contracted the hemorrhagic fever from patients they were treating, died on Tuesday and Wednesday.
Their deaths bring the toll to 18 of medics killed by Ebola since it broke out in Gulu in 2000 -in which at least 14 nurses died on duty alongside Dr Mathew Lukwiya, the then medical superintendent of Lacor hospital. Dr Lukwiya has since been declared a national hero.
"Losing one health worker," Dr Nyangasi said, "means endangering the lives of over 15, 000 people since the ratio of health workers to the population is 1: 15, 000. We call upon the government to be proactive in cases of epidemics; not reactionary like now".
Early this week, overstretched nurses at Bundibugyo hospital momentarily halted work over delayed payment of risk allowances prompting local leaders to offer part payment of Sh30, 000, Sh20, 000 and Sh10, 000 to each doctor, nurse and other support staff respectively for the daily allowance.
The workers' body now says the government should immediately increase the risk allowances to Sh50, 000 per day for all cadres of health workers.
"Those (medical staff) who have no protective gear and are not sure of their risk allowance being paid should leave straight away," Dr Nyangasi insisted.
The Uganda Red Cross Society (URCS) yesterday delivered an assortment of gloves, facemasks, gumboots and Jik detergent among other supplies to help salvage the deplorable situation of health workers at the Ebola centers in Bundibugyo hospital and Kikyo health centre IV.
"There has been lack of protective gear among nurses working on Ebola cases posing a health risk," Ms Catherine Ntabadde, the URCS publicist said in a statement.
Dr Nyangasi had said public health workers hold a right to pull out from highly hazardous working environments under provisions of the Occupational Safety and Health Act, 2006.
Section 37 of the said legislation provides thus: "A (health) worker who removes him or herself from a situation which he or she has reasonable justification to believe presents an imminent and serious danger to his or her life or health shall not be punished or subjected to undue consequences, provided the danger is confirmed by the commissioner (of labour)".
Workers MP Dr Sam Lyomoki, who is also the secretary general of the Medical Workers Union had earlier expressed concern over the ill treatment of medics by the government but said withdrawal of medical services to desperate Ebola victims would amount to "treason".
But Dr Nyangasi said "serious measures" had to be taken to re-awaken the government to the raging plight of the few qualified medical personnel who sacrifice a lot to serve the community.
Asked if the directive to the health workers to quit Bundibugyo does not contravene ethics of medical practice, Dr Nyangasi said, "Medical ethics only operate when one is alive. The right to life is absolute and superior and carries higher priority than professional etiquette".
Dr Sam Zaramba, the director general for health services said the recall of devoted medics in Bundibugyo was "demoralising and unfortunate".
"We do not force any health worker to work in the isolation ward (for Ebola patients). It is quite unfortunate that he (Nyangasi) is giving the instructions (of withdrawal) without discussing it with us (the Ministry of health)".
Yesterday, a section of doctors working at Mulago hospital voiced displeasure at reports that top Health officials are scheduled for an expensive retreat at the luxurious Mweya Safari Lodge in Queen Elizabeth National Park in Kasese next week largely to review work methods and discuss new targets instead of advancing those funds for handling Ebola management.
In an independent assessment, Dr Christopher Orach, the head of community health and behavioural sciences at the Makerere University Institute of Public Health yesterday challenged the Health officials to intensify surveillance because they could be countless unreported or hidden Ebola cases in the countryside.
"Community mobilisers should be trained and empowered to reach out to all areas. They should follow up all those who came into contact with (Ebola victims) for 21 days. Effective clinical case management should also be put in place and health facilities or hospitals should have isolated treatment centres and camps," said Dr Orach.
DR Congo acts
As the Ministry of health reported yesterday that the unfolding Ebola epidemic had killed a total of 22 people out of 93 suspected cases, authorities in the DR Congo slapped a travel embargo at the common border with Bundibugyo district; the epicentre of Ebola.
Sambire Wamukoka, the chief of Watalinga territory in the DRC issued the directive on Wednesday and put soldiers on standby to ensure that no Ugandan uses the Buranga/Busunga border posts to enters Congo and no Congolese crosses over to Butogo and Mahuka markets on the Ugandan side.
Ministry officials said there were a total of 38 patients admitted at medical facilities; 23 at Bundibugyo hospital and 15 at Kikyo health centre.
Mbale suspect
By press time, a team of epidemiologists from Kampala was reported to be heading to eastern Uganda to investigate reports that Ms Olive Mukite, the district information officer of Sironko died yesterday of suspected Ebola infection at Mbale referral hospital.
This follows reports of alert cases in Mbarara, Kabarole, Mubende and Kanungu; where 20-year-old Ivan Asimwe died yesterday.
Earlier, Dr Zaramba said he had drafted a memorandum highlighting the key issues and Shs6b budget details and Prime minister Apollo Nsibambi is scheduled to chair a special cabinet meeting today to address the exploding epidemic.
Additional reporting by AGNES NANDUTU
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