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?