It is 6:40am and the casualty ward is already busy.
Twelve patients are lying on the floor, writhing away in pain after they were dropped there, an hour earlier. These wounded men, they are only men, are crying as loudly as they can but there is no medical attention on the way.
Instead, a cashier can be heard summoning those with pending bills to pay, as a cleaner scrubs the muddied floor for the umpteenth time.
"You are still in deep sleep and can't recognize that blood is flowing from another bleeding patient," a nurse passing by warns the patients on the floor.
However, the patients continue to look on helplessly as she walks away. Next to these two is an agonized man, coughing terribly with tears rolling down his cheeks.
"Mulago is like that; you have nothing to do and even the private wing where patients part with some money for a better service is not any better unless you have a personal doctor to work on you," a frustrated patient attempts to explain their predicament. "You can only hope to enjoy the tea and bread supplied to patients," he continued.
This is part of the gloom that welcomes you to Mulago's casualty ward, located on the ground floor between the hospital's information centre and police post.
Four hours later
At 11:45am, the situation is different. The health workers are more devoted to their work. But the screaming ambulances and private cars are still rolling into the reception area, bringing in more patients - and the ward is now bursting at the seams with people. Consequently, there is a heart-stopping queue at the reception area. Among the patients on the waiting list, are two male UPDF soldiers and their three female colleagues, all referred there from Bombo barracks.
The stranded soldiers cannot communicate to the nurses as they look to be busier, attending to other patients. One of the soldiers, A. Okoya, is hoping to get a new artificial leg as the one he received in February last year has started cracking and caused rotting to his body, giving him a lot of pain.
"This is the third time I'm coming here but no treatment. I rather go to Gulu hospital my homeland and get faster services than remain here in severe pain," lamented Okoya.
Although there is a prominent notice, boldly stating that ALL SERVICES HERE ARE FREE, Okoya has been asked to pay Shs 120,000 for a CT scan before his leg can be changed. Meanwhile, other patients wait for the nurse to usher them into the doctor's room. The nurse registers each patient as they come in and later holds a steady roll-call to invite a patient into the doctor's office. It is an eternal wait, if you are in pain.
To beat the queue, someone calls the nurse over and slips a Shs 5,000 note into her hand to be bumped up the list. Soon he is called in to see the doctor, leaving the rest watching helplessly. They don't call them patients for nothing - only patience keeps them from running mad. Samalie, a patient who came in to see a doctor for her regular high blood pressure check-up has been sitting on a bench in the fourth-floor ward since 6am.
"Usually I come here at 6:30am and wait for the doctor to come in," she says with difficulty in her breathing. "The doctor usually comes in between 9am and 10am and then it is a rush to make sure you are seen before 2pm, when the doctor suddenly has to leave. Once the doctor goes, he will be back the following day."
With the pressure to deal with an increasing number of patients bearing down on the hospital staff, the Red Cross volunteers lend a hand. They are on standby to rush patients brought in by ambulances onto wheelchairs, according to Peninah Nakisuyi, an administrator at the hospital's information centre. She acknowledges that the pressure to deal with the huge number of patients that come in daily makes the hospital look uncaring to the public.
"The ward receives over 200 patients on a busy day like Monday and Friday and about 120 patients on other days," Nakisuyi says. "Of these, at least 12 people die daily due to the shortage of staff to handle their complaints."
Nakisuyi explains that some of these patients arrive in a critical condition, to find doctors already working on other patients. Health workers admit that sometimes patients either die or are maimed for life because of delays in handling their cases. The steady arrival of patients continues even into the night, mostly with accident victims.
Most of those, lucky enough to be admitted, end up in Ward 3B, designed to accommodate only 30 patients to match the 30 beds in the ward. However, with the increasing numbers, the ward has a minimum of 150 patients, some lying on the floor.
Enock Kusasira, the hospital spokesman, admitted that the hospital's casualty ward is the busiest but there is a continuing struggling to avail it with as many health workers as possible, without compromising the other departments.
"The problem with our patients is that they all want to be worked on at the same time, yet considering their conditions, they can only see a doctor one at a time", Kusasira explained.
Despite this, Kusasira urges patients not to wait until they are badly off before going to a hospital.
"Sometimes you come in early and find health workers waiting, other times they are too busy."