A lady called Mary Aliona finds herself in the midst of a storm that is not her doing. By recording and releasing a video of the extremely appalling conditions in which she and others were being held at Masaka Regional Referral Hospital, she incurred the wrath of the Ministry of Health of the Republic of Uganda.
In case you missed the entire episode, Ms. Aliona, a Ugandan woman with no symptoms of disease, was admitted to Masaka Hospital because she had tested positive for the new Coronavirus. This healthy carrier of the virus joined several other women and children in a facility that she described as having been previously abandoned.
Ms. Aliona, who reported that she was a former nurse herself, spoke very respectfully, very clearly and with an urgency that gave voice to what was obvious to the eye. After showing us the interior of the ward, she reported that the medical staff were afraid of the inmates and that their medicines were unlabelled and were dispensed with no explanation.
She alleged that they had no antiseptics to clean the toilets, there was no running water, the toilets were unflushed and that there were no garbage bins. The video showed children and adults in the ward. Whether or not the children themselves carried the virus was not stated. “We feel neglected,” she said. “We are like corpses.”
There was garbage strewn all over the place, a potential source of infections that may have been more lethal than the new coronavirus. “There are some animals that sleep in better conditions than we are right now,” she reported, adding that there was a mortuary and a cemetery next to their ward. Aliona observed that that alone was a source of mental distress. She invited the president to go to Masaka Hospital and check it out himself.
Without the benefit of a proper audit of the care that the inmates were receiving, one is not in position to comment on that aspect of Ms. Aliona’s report. However, there are a number of things that invite censure even without the benefit of a physical visit to the facility.
First, admitting symptom-free carriers does not make sense at all. It is a waste of the country’s very limited health care resources on non-patients. The limited resources should be saved and used to treat real patients, the vast majority of whom are afflicted with non-Covid-19 illnesses.
Second, mixing children, who are presumably virus-free, with infected adults is unconscionable malpractice. Children are susceptible to Covid-19, with some of them at risk for very devastating illness.
Third, whereas symptom-free carriers should self-isolate in their homes, one appreciates the difficulty of achieving that in a society where multiple people sharing a house is the norm. One also understands the concern about symptom-free carriers sneaking out of their homes or receiving healthy visitors. The solution to this is to quarantine these individuals in clean facilities, such as hotels that offer self-contained single rooms.
The cost of such hotel accommodation can be easily met by the financial war-chest that has been allocated to the fight against Covid-19. It is this sort of consideration that we have been advocating in our appeal to the government to shift priorities from paying money to politicians for their pretentious role in fighting Covid-19, to the real frontline needs of the effort. There is enough money in the treasury. The problem is its misallocation to feed the appetites of the ruling class and their cronies.
Fourth, in response to Aliona’s report, the Ministry of Health stated that the facility in the video “was used as an emergency measure as the hospital expands its bed capacity to over 50 to accommodate more patients.” In fact, the filthy state of the environment in which these inmates were detained was utterly unacceptable.
A place like that must never be used for human habitation, not even as a temporary holding facility for ten minutes. It poses greater risk to the health of the inmates and the staff than the new coronavirus does. Everything about it was against the most elementary concepts of hygiene and public health.
After seeing the environment in which Aliona and her fellow inmates were being held, I had no reason to doubt her other allegations about the care they were receiving. One would have expected the Ministry of Health to gratefully acknowledge her evidence-based report, take immediate measures to evacuate the inmates from the filthy environment and ensure corrective measures to provide the detainees with care that met the minimum standards of good medical practice.*
Instead of immediately welcoming her patriotic act of raising an alarm about what were obviously very dangerously substandard conditions, the Ministry’s public relations machine went into overdrive in a campaign to paint her a villain. This, of course, was a self-indictment by the Ministry. Defensive reactions in the face of criticism is a typical characteristic of a dysfunctional organization.
One struggles to find the right words to describe how unacceptable the Ministry’s attitude is. Instead of acknowledging the substandard conditions that were clearly evident in the video, the Ministry of Health broke patient confidentiality by telling us how Ms. Aliona ended up under their care. A cardinal rule of ethical health care practice is that, no matter the provocation, one must never disclose any information about a client without her consent.
Over the last three months, President Yoweri Museveni and his Ministers of Health have earned well-deserved respect for the way they have handled a potentially dangerous situation for which the country was very ill-prepared. No doubt they have made a number of serious errors, among them the usual financial wheeling and dealing, the suspicious awards of contracts, poor delivery of promised services like food and masks, and the spectacle of ministers and the prime minister involving themselves in things that should have been handled by technocrats. However, I, for one, have been impressed by the president’s uncharacteristic deference to the medical professionals in a potentially serious crisis.
Unfortunately, Mr. Museveni’s government’s reaction to Ms. Aliona’s report has exposed the truth that whereas the top leadership has been saying the right things, the rot underneath remains unchecked. Their well-earned reputation has been shredded with the ease of ripping up a piece of paper. They have undermined public confidence.
A presidential visit to Masaka Hospital, an apology to Ms. Aliona and her fellow inmates, and a directive and funding for immediate remediation of the dangerous conditions in which patients are being nursed at Masaka and elsewhere may help repair the damage.
*Addendum: On the evening of Monday June 29, 2020, Ms. Aliona posted a video in which she reported that the authorities had responded to her earlier video by discharging five of the inmates. Furthermore, the polythene base of the tent in which the male inmates were being held was being cemented. A sweeping broom has been provided to clean the bathrooms and a garbage bin has been installed.