Thursday, May 30, 2013

Healthcare in Uganda: Mulago Hospital

Today encompassed two very eye-opening, enriching looks into Ugandan healthcare. I will summarize our afternoon visit of the day, a tour of Mulago Hospital, the largest hospital in Uganda. As we walked through the hospital en route to an introductory lecture, it became apparent Mulago was strikingly different than the American hospitals we are accustomed to. There are no waiting rooms in the Mulago Hospital; rather, friends and family of patients find free spaces on the ground within the open-air building to rest, eat, and wait for loved ones.

To begin our tour, Professor Josaphat Byamuigisha gave a short presentation summarizing current health care issues in Uganda, focusing specifically on obstetrics and gynecology, the department which we would later have an opportunity to see for ourselves. I will highlight a few striking and significant facts from his presentation. Mulago is a public hospital, which offers "free" services to citizens. I was advised by the MUBS students, however, that the situation is not quite so straightforward. The hospital has a private sector, and generally offers better, faster services to those who are able to pay. Mulago faces major issues in providing adequate healthcare in gynecology, including an extreme shortage of staff, supplies, and space, patient-induced abortions (illegal in Uganda), high prevalence of fistulas, and cultural norms of having several children, often without maternal healthcare. An American woman, currently completing her residency in Boston, happened to be doing rounds in Mulago at this time. She spoke to us about making a difference in this hospital, and the stark contrast we would see from U.S. hospitals.

After this short lecture, we split into two groups to tour the gynecology and obstetrics ward. By no means am I exaggerating by saying the experience was absolutely shocking for many of us. Our views of healthcare and privacy were inverted, twisted, and split into a million pieces.

In the post-operational room, over twenty beds and patients were held in a medium-sized room. Patients were no more than two feet from one another. As startling as this may seem to us Westerners, the resident informed us that this ward had much more space than most. We were given free reign by the hospital staff to enter the wards and observe patients - an act that seems like a monumental breach of privacy and respect to me. Furthermore, we walked into the delivery room - another medium-sized room filled with twenty-some women. In this room, however, all the women were in labor. A small curtain surrounded each bed, but the nude women were still visible to us. A just-born, premature baby lay on a table near us; it uttered its first cry as we stood nearby, with no one to comfort it. The scene was beyond alarming - almost indescribable. A sign posted in the ward stated, "Women, please take your babies with you when you leave. Do not throw your baby in the dust bin. Police are watching. You will be prosecuted."An unsettling knot festered in my stomach soon after reading this.

While in the hallway, the resident informed us that after giving birth, women lie in the corridors outside the ward to rest up until the next morning; they leave shortly after this. Typically, two midwives serve sixteen women in labor at a time. Often times, women are forced to go into labor on the ground. The hospital regularly delivers 80 babies in a span of 24 hours. These facts are unbelievable and mildly disturbing compared to American maternity care.

Despite these scenes, I was remarkably impressed by the poise and courage of the hospital staff. Undeterred by the severe shortage of staff, space, and supplies, the doctors and nurses were putting their absolute best efforts forward to take care of these women. While many doctors choose to work in other countries, seeking higher wages, one doctor stated firmly that Kampala was her home; she would serve the people here. Her pride and resilience in the face of incredible adversity was inspring.

Students - What was your reaction to the hospital visit? How do you think conditions can be improved? What role does the government need to play? What role should international donors play?

4 comments:

  1. Personally, I dis not find the conditions all that shocking. I thought Katrina made a really good point by saying these are not bad people or bad doctors. They are doing the best that they can with what they are given. As f

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    1. As for what can be done that is an extremely difficult question to answer. One appoach would be to throw supplies at them, however, people are going to steal it. I know with the medical supplies that Katrina was receiving for the hospital she said that she would only trust about four people with it once she left, because they would sell it. They are poor people not bad people. I think that is important to remember. If you directly improved the conniptions, sadly more problems would most likely be created. Regarding healthcare in Uganda, there are structural issues. In my opinion, the government should make healthcare a priority and the role of NGOs should be decreased. Ugandans need to believe in their government and take ownership for their issues. NGOs can help but that is not going to be a successful long lasting solution.

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  2. I thought the hospital visit was pretty sobering and really made me appreciate the health care system that we enjoy in the US.
    I think what makes addressing the health care issues in Uganda so complicated is the fact that the overall corruption of the system is so multifactorial. There is no one easy solution; instead there is a combination of lack of funds, staff, physical locations, transportation, and the existence of a culture that is more focused on cures than preventative care that results in the damaged system that exists today.
    I think it's important to note; however, some positive things about the Ugandan health care system instead of focusing entirely on negatives, as I have a tendency to do. Many of the doctors that I had the opportunity to speak with seemed to have a passion for their job and a desire to improve the system. These are the kinds of individuals a nation needs to have in order to ever hope of improving their system. Secondly, the system that currently exists is attempting to provide diagnosis and treatment to citizens free of charge, which shows the theoretical value that the Ugandan government puts of the health of its citizens. Given time and resources, their system might be able to fulfill these goals as they originally intended to.

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  3. I would like to echo what Lisa Beard has said about the conditions at Mulago. To me, they were very humbling and made me really appreciate the much ridiculed health care system in the US. It's obvious that the problems within the health care system are very complex and intricate. If they were easily solvable, the Ugandan people would have long solved them. Should we provide more supplies? Should we build more facilities? Should we hire more staff? I think that the answer to the health care crisis in Uganda lies within a culmination of all three of those. More supplies would lead to better care for patients and more facilities and more staff would enable more Ugandans to access the health care. However, the million-dollar question of how still looms. The best solution I can think of starts with the government. The government of Uganda must take a special interest in and higher priority on the health of their people.

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