The Independent (Kampala)

17 February 2013

Uganda: 'I'm Going to Cut Off Your Leg'

It is 12:30 and although accident victims are supposed to get relief here, the afternoon heat and stinking air in orthopedic ward 3AOC of Mulago National Referral Hospital in Kampala is no relief at all.

The walls of the ward that look like they used to be yellow are now brownish thanks to different coatings from sweaty dirty palms and bloodstains that also dot parts of the dusty rough floor.

Lying on one of the plastic covered mattresses is Timothy Yiga, a 24-year old boda boda motorcycle accident victim. Apart from the pain from his broken leg, Yiga is sweating profusely. The thin sheet on the bed only covers half of his body, leaving the rest of his body unprotected on the torn-plastic covered foam mattress and its dirty black patches of dried blood stains.

"It's too hot and my leg is paining so much," he says as he struggles for breath with a bandaged head that was also injured in the accident.

Ward 3AOC Orthopedic Ward is where most motor accident victims are admitted. Most of them are either boda boda, motorcycle taxi riders or passengers.

Grace Zawedde, the nursing officer of in-charge of Ward 3A says that the number of victims can go up to 60 for a ward designed for 20 leaving other patients to lie on the floor waiting for others to be discharged in order for them to get treatment. It does not matter if it is a broken limb, a damaged skull, or any potentially fatal injury; if the beds are full, there is little Zawedde and her team can do to help. The victim has to wait on the floor or outside in the corridor, while wailing in pain.

Shaban Ssebuliba, a customer care assistant at the hospital says many patients arrive in devastating conditions but cannot be helped immediately due to the limited space.

"That's why most of them are found lying in the hospital corridors however our nurses and doctors always do their best to save their lives," he says.

Old mattresses and torn lives:

On the bed next to Yiga is Frank Suuna, who has seen so much pain in this ward that he is now capable of saying conditions are much better.

"When I first came here, I thought I was going to die the next day," Suuna, accident victim, says, "The place was teeming with accident victims; the bed I was to be laid on had a sheet with blood stains all over of a patient that had just been discharged. The situation made me cry and fear for my life."

Suuna who is recovering well says the ward is not as congested now and in fact several beds around him are empty, and there are two nurses attending to the other patients.

A thin dirty heavily blood stained sheet held together by mere threads covers the beds next to Suuna's. It is waiting for the next patient.

According to a recently released report, 'The State of Referral Hospitals in Uganda report 2012", the conditions of patients, staff and facilities at Mulago, as in most referral hospitals of Uganda, are disturbing. Referral hospitals lack drugs and adequate numbers of health workers and facilities. As a result, patients cannot get appropriate care, and are sometimes neglected resulting in avoidable deaths.

But it is clear that some local interventions could create some improvement. Mulago has an army of cleaners, but the wards remain odorous, with dirty walls and dusty floors. The situation is worse in the toilets. The sinks for washing utensils are stained with dirt that looks like it has accumulated over centuries.

Experts say these wards require renovations and much better facilities if the situation is to improve.

With the lack of equipment like bed trolleys for emergency cases and other facilities, it has been hard for the orthopedic wards to deal with the big number of people involved in accidents.

The government through the ministry of Health allocates funds to Mulago Hospital to cater for basics like water, electricity, and equipment in general. The urgent but specialised wards like the Orthopedic and Neurological Wards, are often ignored.

Mulago Hospital was last renovated in 2007 in preparations for the Commonwealth Heads of Government Meeting, (CHOGM), since then, minor renovations have been made yet the numbers of patients skyrocket by the day. Janet Namwema, the deputy in charge of Surgical Ward 3B, limited space is the most pressing constraint.

Too many patients:

On Suuna's other side, another accident victim who can hardly talk, keeps turning in pain and mumbling inaudible things. No one is attending to him. A nurse says despite preliminary treatment, that patient can still not talk and as a result no one has been able to identify him or his relatives.

His swollen eyes are covered with a cake of drying blood and his body, wrapped in a thin green cloth, lies on the bare plastic-sheet covered mattress that too looks sticky from different coatings of sweat and other unidentifiable elements. The ailing man's only belongings, a pair of faded jeans and a threadbare shirt hang on the bed post above his head. It is painful to imagine this already battered soul shivering and turning from the sting of cold on a cold night.

Mulago Hospital admits over 38,000 victims of accidents per year or about 100 victims every day. All these are taken to Orthopedic and Neurological wards to receive their first treatment.

"It is too much; the numbers are high and yet our working space is limited," Zawede says, "We do our best to improvise and provide the best services possible even when the cases are fatal."

Enock Kusasira, the hospital Public Relations Officer says patients come from all over the country. On the day we visited, there were patients from Kanungu, Kabale, and Mbarara in western Uganda, Nebbi and Gulu in north, and Mbale in eastern Uganda.

Kusasira said the patients are brought in with a lot of personal luggage which, together with their attendants and visitors, often contributes to the congestion and poor hygiene of the wards.

Zawede says often when patients arrive, they are shocked by the congestion and live in fear because of the painful conditions of the other patients.

Medical experts say that in hospitals where numbers are high and the service delivery is limited; there is a lot of suffering and trauma that affects the emotional, mental, physical and psychological being of those involved.

A nurse on the ward told The Independent that when some patients find other accident victims in worse conditions than theirs going through too much pain, some are overwhelmed and run away from the hospital. When some tell the nurses that they are leaving and are blocked, some opt to escape. Unfortunately, the nurse said, they resort to other methods of treatment such as traditional healers and by the time they come back to Mulago, they are in a worse state.

The doctors and nurses are very few and are often harried by hardship and burdened by numbers. Sometimes they act harshly, blaming the victims of accidents, especially boda boda motorcyclists for being careless.

"We are going to start chopping off your legs because you are killing people," one nurse reportedly threatened Brian Sekitto, a boda boda cyclist.

Sekitto says the nurse only meant to scare him, but he is unwilling to let bodaboda riders take all the blame for accidents.

"At times we are not the ones in wrong when these accidents occur," he says.

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