State-of-the-art health services an affordable necessity

My wife and I spent the whole of January 2012 in Kigezi, falling in love all over again with my homeland and her adopted home in Uganda. Most of our stay was very pleasant, the hospitality a sweet reminder of what we missed most about our country.

However, three heartrending images are indelibly seared onto our minds. Two involved two little children, whose stories we shall tell later, and one was of a man whom we found hovering between life and death.

On Saturday January 14, 2012, I strolled down the old boulevards on Makanga Hill, taking pictures of my childhood haunts. As I approached Kabale Regional Referral Hospital, I met Rugwiza wa Semiriho, my childhood friend, who introduced me to four young businessmen - three boda boda operators and one cab driver - who enriched me with their common sense and knowledge of the realities of Kigezi.

As I stood transfixed by their narratives about the challenges of healthcare in Kabale, a young woman approached us and requested Byaruhanga, the cab driver, to help her take her husband to their home in Kaharo so that he could die there.

“It is cheaper to transport him alive than when he is dead,” the woman stated with a matter-of-fact tone that was only betrayed by her sullen facial expression.

A bus had hit her husband the night before, which had left him with a potentially fatal fracture of his skull and other major injuries. A doctor at Kabale Hospital had attempted to operate on him but had abandoned the procedure upon realizing that it was beyond his competence. The man, semiconscious and still bleeding from his wounds, was receiving a blood transfusion. Should he survive until Monday, he would probably be transferred to Mbarara University Hospital, 140 kilometers to the east. She had no money and was not about to undertake the long journey to a strange place with a man who was as good as dead.

I entreated the woman to let me visit her husband to see what, if anything, could be done. With evident hesitation, the woman led me to her husband’s bedside in the Surgical Ward, a thirty-something bed unit that had a patient census more than twice the official maximum.

There was a vigil by the man’s bedside. Death was in the air. The solitary nurse looked resigned, many of her charges too sick to give her hope of saving their lives. Those who needed treatment in places where more advanced surgery was available were handicapped by poverty, among them CB, the woman’s husband. A trip to Mbarara University Hospital would cost the woman in fuel fees and allowances for the health personnel who would accompany him. The woman had taken the only logical option available to her. CB would have to die at home.

Kabale Ambulance interior: unaffordable fees

However, after some discussions, the hospital leaders agreed to transport the man to Mbarara immediately, at no cost to the woman. Someone offered the woman a modest donation of cash for her upkeep and transportation and we wished the couple God’s speed.

CB underwent neurosurgical treatment within 12 hours, news that was relayed to us by his wife via cellphone. Less than a week later, CB was reported to be walking around Mbarara Hospital.

On the morning of Thursday January 26, 2012 my cell phone rang. On the line was CB himself, reporting that he had just been discharged, with a clean bill of health, now on his way home to Kaharo, to live, not to die.

My wife and I had our bags packed and ready, for we were leaving for Mbarara. We would not see CB and his wife and would content ourselves with the deep satisfaction that our prayers had been answered. Perhaps we would live long enough to visit him in his home one day.

Our joy over CB’s recovery was tempered with the knowledge that he had just been a lucky man. His story could have been different, as we knew had happened to hundreds of others around the country who could not access the basic treatment that saved CB’s life.

Fully equipped and fully staffed Emergency Department a necessity at every hospital

Furthermore, should we need emergency life-saving surgery ourselves, Kabale Hospital might not do it for us, not because they would not want to but because they lacked the human and material resources that should be at a Regional Referral Hospital.

I am aware that people like CB do not appear on the moral and mental radars of the ruling classes of the land. Their premature deaths are mere collateral damage in a war on the Animal Farm of greed and economic exploitation that Uganda has become.

However, one question I have asked before warrants repeating. What if a catastrophic disaster struck any of Uganda’s district or regional centers, with the top rulers of the land among the casualties?

The logical response would be that they would be evacuated to the safety of Nairobi or South Africa. Perhaps the state of the art mobile presidential hospitals would be put to use, even as the Gulfstream jet’s engines revved at Entebbe, awaiting the injured rulers to arrive by helicopter.

The realistic answer is that there are injuries that require immediate medical and surgical management in facilities that offer in-house stabilization for several hours or days, prior to attempting the hazardous transport of a critically ill person – even when that person is the president or prime minister of the land. If for no other reason than self-interest, a shift of priorities to invest in functional and truly state-of-the-art health care services is worth consideration by the rulers of the land. Such investment must go beyond good-looking buildings.

Under construction: Kabale Hospital New Outpatient Unit, August 4, 2015

Kabale Regional Referral Hospital recently took possession of two lovely buildings, constructed with a grant by the Government of Japan. The buildings will house a Maternity Unit, Emergency and Outpatients’ Departments and Operating Rooms. This, of course, is worthy of celebration. However, these new facilities need an adequate human resource available 24/7, ready to deal with all emergencies until evacuation to the larger centers.

They need serviced, fuelled and ready-to-go ambulances at all times. These ambulances should not be transportation vehicles with flash-lights. They must be mobile facilities with highly trained personnel to ensure excellent outcomes for the patients.

This is as true of Kabale as it is of all major towns all over East Africa. The good news is that these essentials are affordable. It is a matter of priorities.