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Wednesday, June 9, 2010

mulago hospital

If Uganda ever issued a FLOOD WARNING today would have been the day! Our entrance into the hospital was first stalled because of a rapid fury of rain drops. Once we finally entered the facility we walked through the assessment area where the potential patients waited to see if they would be admitted into the hospital. It was quite a sight to see because people were everywhere! They were sitting in the chairs, standing along the walls and sitting on the floor in every direction. Once we entered the board room we were introduced to Mr. Ssekabira who was the executive directors’ public relations guy. He took us through the hierarchical system of Uganda and explained to us how their health care system worked. There are 5 levels to their system, the lowest forms are titled Health Care three and Health Care four and the government primarily focuses on these two levels. The third level is distributed in every district and is called the District Hospitals. The next two specified levels of the health care system are considered referral hospitals. The 2nd most comprehensive level of health care is received at the Regional Referral hospitals and there are 11 around the country of Uganda. The most comprehensive is the one we visited called Mulago, it’s the National Referral Hospital and is the only one in the country. Mulago accepts only patients who are referred and who are in emergency situations. Mulago’s services are very comprehensive and have a range of departments and categories from acute pediatrics, to labor, to AIDS care. Mulago hospital also has an outpatient clinic for the less life threatening cases for those surgical/medical procedures that cannot be handled at any of the lower facilities in the country. We also met with Dr. Fred who is a physician of the hospital as well as an AIDS specialist and took us into depth about the services they offer to HIV/AIDS stricken individuals. They considered Mulago a tertiary institution with upper level surgical procedures, but said because of the nature of the location they use this as a primary care unit-which it is not. For their AIDS unit they have 2 comprehensive categories: preventive services and clinical care. After our discussion in the board room, a munch of medical focused students took a tour around the facility and we were able to see the pharmacy as well as a medical ward. They were both a sight to see because of the low supply of drugs as well as the overcrowding in the halls...


The public relations guy said "that the health care system is broken down and does not work properly and says that the overcrowding is mainly due to the minor ailments that get admitted to Mulago". If the national hospital has the best of the best, do you think that it’s fair to turn away individuals for their “minor ailments”?

What role does health care access play in the sustainable development of an economy?

Do you guys think that quality health care is a necessity for development to occur?

Given the sights we saw at Mulago, if you had the chance, what range of services would you use funds towards to emphasize? Access to drugs? More technology? Training for doctors? Preventative health care? Which would be the best for the sustainable development for the country?


  1. Our Mulago visit so incredibly eye opening. I didn't realize before we got to Uganda what a problem access to health care really is.

    I think it is fair to turn individuals away from Mulago for having minor ailments because Mulago is a referral hospital. It was set up only to take appointments with people who had been sent to them because their problems are beyond the abilities of district and regional hospitals. This would not include minor ailments. It is unfair to the patients who need the referral appointments to give doctors' time away to head aches and bruises.

    Access to health care is vital to a country's development. If people are ill and need medical attention but don’t have access to it, they cannot work. If they cannot work, they cannot make money to support themselves and their family. This puts less money into the economy which slows down the development of the country. These people then become dependent on others and possibly even the state. This creates an even worse situation in the economy with a misallocation of productive resources.

    In regards to Mulago's available services and resources, I would emphasize access to drugs. The drugs available in the hospital pharmacy were incredibly limited. A hospital, especially one so important in the country, should not only have enough of all medicines conceivably necessary, but also extras. A doctor, no matter how well trained, cannot cure a patient if he or she has no medicine to treat the patient.

  2. Visiting the Mulago Hospital was an eye opening experience for me! Personally, I hate going to hospitals. It is something about seeing people who were once strong, ill and in a bed! Mulago definitely didn't change my opinion. When walking in I saw a ton of people overpopulating the waiting room. There were sick people everywhere. There weren't enough chairs available so many people were laying on the floor! It was so hard looking at these people suffer on the floor waiting to be helped. This experience made me grateful for the quality of the American health care system.

  3. I was also shocked at the condition of Mulago. I was expecting health care to be pretty poor in Uganda, but not to this extreme especially since it is the largest hospital in Uganda. As Matthew said it was extremely crowded and unsanitary. Our guide told us that during the flu season they have an excess of 500-1,000 patients admitted! I was also surprised to learn that the patient:nurse ratio is huge so patients are pretty much required to have a family member at their bedside to do the nurse's job (even such things as changing IV bags). They also do not have an electronic charting system which greatly slows down the entire process.

    So, if I were to pick two areas to focus funds on to achieve sustainable development I would pick infrastructure and availability of drugs. For infrastructure I think it would be beneficial to either build a new hospital or create better coverage by carrying out the referral process they have set up more efficiently so that Mulago can truly focus on the more severe cases and the patients with "minor ailments" will know to not go to Mulago and instead go to the smaller centers. Also improvement in infrastructure would include setting up an electronic system so that everything from charting to inventory to communications can be improved. Making the system more efficient will in itself push towards development. In terms of access to medications, I pretty much agree with Kjersten. Drug inventories need to be able to be consistently restocked (as was not the case at Mulago) and also they need to be available for either free or a very low cost - but this is very hard to achieve without depending on foreign aid.

  4. I was really surprised by the conditions of Mulago as well, especially after the talk and knowing that it's the National hospital. I think it was pretty bad that the central pharmacy did not carry most of the medications patients needed, but instead forced them to the pharmacy down the street. I think the worst part about the hospital though was the short-staffing. It was bad enough that people were overcrowded into wards with no organization or space, but most of them did not even see a nurse or doctor. If it's not a severe case, I did not even understand why these people would want to stay at the hospital. It was just about the same care they would get at their own homes. If the hospital was properly staffed, it would create a lot more jobs for nurses and techs, which would in turn help the economy. It would also improve health care and the treatment for patients.

  5. The experience at the hospital was eye-opening for me as well. It was sad to see all the people waiting to be helped. Sam explained to some of us that often times the hospital is over croweded and patients with out beds sleep in the hallways. Sometimes, admitted patients die before they ever get to see a doctor. Also, Mulago has no nurses, patients need to bring a relative to care for them and make them food.

    I do not think it is fair that patients get turned away for minor ailments, but it makes sense to help those who are in more need first. I think the government needs to focus on providing better access to good healthcare. Mulago is the only hospital in the country that provides many of the services it does. It would be less crowded and more beneficial to the people if other hospitals around the country could provide better medical care as well. Quality healcare is very necessary for a country to develop. If the people are not healthy and able to work and raise their families, they can not be productive members of the economy.

  6. Mulago hospital was one of my favorite days of the trip because I feel we were really able to get a better understanding of the health care profession. We were able to get more information about AIDS care and treatment, availability of drugs, quality of care, and crowding in hospitals during our visit. Something that really shocked me was during my tour of the pharmacy; it was here that I learned that the hospital only stocks drugs on the WHO Essential Drug List. This means that there are many drugs the hospital pharmacy does not carry. In situations that the hospital does not carry a medication a patient needs, it is then necessary for the patient or a family member to go to a clinic or another pharmacy to obtain the drug.

    I feel that availability of medication and quality of health care are two things that are very important when thinking about the sustainable development of Uganda. As we learned during our human rights talk, everyone deserves access to quality heath care services, and this includes access to needed medications. Currently it seems the system does not offer the best services to the citizens of the country. Though international aid has began to fall in the past few years, Uganda needs to make health care a priority. It is important that health care professionals figure out sustainable ways to develop services and medication availability to all citizens of Uganda in need.

  7. Mulago was also one of the most suprising experiences for me. I wasn't too sure what to expect before we went, but I was definitely shocked at the conditions that we saw and some of the information we learned. One of the most interesting things I remember was seeing the endocrinology ward. Some of the health science and pharmacy students were taken on a short tour after the presentation to see the rest of the hospital. We were taken to this ward to get a sense of what it is like for the patients who have to stay there. It was extremely overcrowded as others had mentioned, and it was weird to see so many beds in an open space instead of patients having their own rooms or sharing with one other person.
    After seeing this hospital, I think health care is one of the most important things that has to be changed in order for the country to develop. Healthy people make a productive society, so it is absolutely vital that everyone can receive the necessary care. The government provides funding for this hospital, but it just does not seem to be doing enough to help the people. They have to find a way to fix their system of health care so that it will benefit the people it promises to help.