The Observer (Kampala)
Carolyne Nakazibwe
19 November 2008
When we turned up on November 5 for what the doctor prescribed - a nucleosis scan only available at Mulago National Referral Hospital - the patient and I were pleasantly surprised at how fast that went.
Within 30 minutes, we had repeated the Thyroid Function Test (TFT) and had the scan, all at Shs 80,000 ($43). We had turned up with TFT results from the respected Ebenezer Clinical Laboratory but the hospital only works with their own test results. It seemed too late to start mourning about the Shs 90,000 ($49) the Ebenezer test had cost, not to mention the Shs 170,000 ($93) for a CT scan and Shs 30,000 ($16) for an X-ray at Kampala Imaging Centre.
The patient had what looked like a developing goitre and our search for a cure was on. But as we looked at the elderly nurse at the Nuclear Medicine Unit with expectation, the pleasantness of the afternoon ended. She announced, the results could only be picked on November 11. That was six days away.
In the private sector, all the aforementioned tests had taken us two days - complete with interpreted results.
Already, the coughing fits from the patient were worrying. Six days before we could present ourselves before a doctor again for treatment? On the way home, like countless Ugandans do, we stopped at a pharmacy and got ourselves some drugs over the counter for the cough.
But the true picture of what millions of Ugandans go through every year at the biggest hospital in the country was about to hit us.
With an appointment of midday on November 11, we lost no minute getting to the Nuclear Medicine Unit.
Outside the department's door, about 15 people were waiting. There seemed to be little or no activity inside the unit itself. We were informed all these people were waiting for their scan results. Some had been coming back for two weeks and felt we were too impatient to complain after a few minutes.
2.00p.m. A female doctor walks in. I am told her name is Dr. Agatha Nambuya, a specialist endocrinologist. She looks to be in her mid-50s. One by one and for agonizingly long periods, the patients start going in to see the doctor for their results. I am informed by the gentleman to my right that she is the only one who can interpret the scan results for the patients, despite the availability of three technical persons to carry out the actual scanning.
The gentleman has been waiting for his results for two weeks; results he needs before his doctor can send for the required drugs from South Africa.
3.30p.m. The gentleman to my right, who tells me he is a Rotarian in the same rotary club as the Mulago Hospital Director Dr. Ddumba, is called for his results. A look of relief floods his face as he leaves.
A young nurse walks in with a rich-looking gentleman in his early 60s. She leaves him outside and goes in to talk to the nurse on duty. I discover the gentleman is from Lango sub-region but works in Kampala. His problem: he has lost use of his right hand and the neck is developing strange reflexes. More than Shs 500,000 in tests and treatment has yielded nothing, so the doctor has referred him to Mulago.
3.42p.m. The Langi patient loses his cool: "When [former President Apollo Milton] Obote was shot in the cheek, I was a young man. But he was brought to this hospital. No one flew him out of the country! But now? Even when you have money it is useless. And to think this is Mulago! In other words, when you fail to get help from Mulago it is better to buy your coffin on your way out of here!" he says, causing the first laughter from the tense queue.
I break it to him that we have actually been waiting for three and a half hours - some more - for results of a test we took six days ago. He looks back silently, eyes wide with disbelief.
3.53p.m. We have still not got our results. The talkative patient walks away and that leaves three of us in the queue. I pull out my phone and call Mulago Hospital's Spokesman, Eliphaz Sekabira. Because if it looks like a story, smells like a story, tastes like a story, then chances are, it is a story.
I read him the picture at the Nuclear Medicine Unit.
"We do have a problem there. There is only one specialist in that unit and she has to lecture at the Medical School, do the ward rounds and see patients at that unit too. We cannot afford to pay a specialist from South Africa right now," he says. A few minutes later, he comes to the unit and talks to the staff, but clearly the situation is out of their hands. As he walks out, he assures us: "you will have the results today."
A woman in her 40s walks out of the doctor's room and stops to chat. She has been on goitre treatment for 8 years, due to her irregular income patterns.
"When I get some money, I come to Mulago for medicine and check-ups. When the money runs out, I look for casual work in my village to finance the next dose. If it wasn't that, I would be okay by now," she says.
She is on a drug that costs Shs 350 a tablet and at one point she needed 30 tablets daily to reverse a goitre too complicated for surgery because it is entangled in her veins.
4.05p.m. Esther the radiologist calls us in. Finally.
We walk through a very cold room where the scan is done, into a back room where Dr. Nambuya sits with two junior doctors she is teaching her craft. Their name tags read Dr. Tutaryebwa and Edith Nyangoma. Behind them, a computer with the patient's scan results is on. The consultation lasts about 30 minutes and I realize why the wait has been so agonizing; the doctor is teaching her wards how to tell goitre from anything else, how to detect a thyroid cancer and how to make necessary prescriptions or recommendations.
The three doctors show no signs of irritability or fatigue and are quite professional. Even pleasant.
In the corner of my eye, I see another patient being shown into the room; the nurses' way of making sure the doctor does not walk out on the rest of the patients, as is common in the hospital.
Dr. Nambuya glances at the new arrival - a nurse, going by her uniform - and asks if she needs help. The young nurse indicates that she is a patient today and the doctor smiles.
As she finishes up with us, she sighs and tells her charges, "I am so tired; I have not even had lunch yet!"
Then she turns a smiling face to the next patient.
5p.m. We finally leave Mulago Hospital gates.
I leave wondering what the wait is like in the free departments of that hospital. What we had just received, mind you, is private patients' treatment!
One week later. I return to Mulago Hospital on a fact-finding mission. First stop: Dr. Nambuya's office.
In an interview, she says the big number of patients she sees is as a result of the increasing cases of goitres, although she does not have exact statistics.
"But it is a lot more than in the past years. A large number of Ugandans come from volcanic areas of the East and West and the food and meat from those areas has no iodine," Nambuya says. The thyroid is as a result overworked, especially among women who have a bigger demand of hormones, causing it to swell into a goitre. In men, the presence of a goitre in many cases is a symptom of cancer, Nambuya says.
"Fortunately, cancer of the thyroid moves slower than other cancers, so it can be contained."
So why is there too much work for too few people in the Nuclear Medicine Unit, I ask. Nambuya says the Nuclear Unit not only scans and treats thyroids, but is the high specialty technology for scanning of body tissues, including the liver, brain, kidneys, heart and more. But not everybody can interpret the results from this scan.
"The unit was set up by the United Nations' International Atomic Energy Agency, which provided the equipment and trains the workers," Nambuya says. It was updated in 2004 and is currently the best unit in the Great Lakes region!
The unit's operations were recently legalized after Parliament signed the Atomic Energy Bill, an international requirement before any country can use radioactive materials. The material used for scanning (Technetium) is, according to Nambuya, imported from South Africa.
Nambuya was one of six doctors and five technicians trained for the unit; her five colleagues have moved on to other jobs outside Mulago, leaving Nambuya the lone physician in the Nuclear Medicine Unit. She is also in charge of the diabetics unit under the Department of Medicine, and occasionally travels nationwide setting up diabetics clinics. She is also a lecturer at the Makerere University Medical School, on top of seeing other patients outside the Nuclear Medicine Unit.
With a schedule like that, no wonder patients wait for weeks to get their results. She tells me on the Tuesday I was there, she left at 6p.m.; sometimes it is 8p.m.
"I am soon going on annual leave. I don't know what will happen here, but I have to take the leave, otherwise I will die!" the senior consultant says.
Of the five technicians trained for the unit, one died, one retired, one was transferred, another works for Bank of Uganda and the fifth is abroad on training. That leaves the unit depending on technicians from the Physiology Department.
I ask Nambuya about her salary but she says, "If you work in the medical field and think about payment, you will never work. God gives doctors a special brain."
Second stop: The office of another senior consultant. He tells me on condition of anonymity, that Mulago's biggest problem is the ban on recruitment that has been on for years.
"People retire and die, but there is no replacement. Even those who come out of Medical School are not absorbed," he says.
When I ask about his salary, he pulls out a pay slip that indicates gross salary of Shs 2,100,000 (approx. $1,141) and a take-home of slightly more than Shs 900,000 (approx. $489).
"It goes into taxes. Even the allowances are taxed. And this is senior consultant level," he laughs. He says that is why for almost every consultant in Mulago there is also a clinic in town.
"That is where the money to pay our children's tuition, fuel our cars and put bread on the table really comes from. Not from Mulago."
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