Upon learning that he would not get eye surgery because he had not carried his medical letters, Isaac Kakooza, 70, breaks down as his only hope to regain sight melts away. The scene is at Masaka Regional Referral Hospital where Rotary Club of Masaka and Rotary International have organised a free medical camp.
Twenty two senior surgeons from India have come to carry out surgery on patients with ailments such as eye defects, hernia, goitre, and dental problems. However, beneficiaries have to present medical letters as proof that their ailments need surgery.
A medical camp is a temporarily organised activity within a specified locality for purposes of providing free, subsidised or sponsored medical, surgical, dental diagnosis and or treatment.
For Kakooza to get eye surgery from a public hospital, he needs to go to either Mulago National Referral Hospital or Mbarara Regional Referral Hospital because Masaka hospital could not offer the surgery. Dr Sarah Nassali, the head of the eye clinic, says they do not have the necessary equipment and personnel thus referring most patients to Mulago hospital.
“Most people do not have money for surgery. Some operations cost as much as Shs2m per eye. Many just go blind after giving up,” she says.
Kakooza’s situation and the many patients who failed to get treatment and the disappointment shown, shows how many people in rural areas are left to depend on medical camps for diagnosis and treatment of various ailments.
Prior to this health camp, Bulamu Health Care International, a US-based organisation had in May organised a similar camp in Kyanamukaka. But a ‘sincere’ observation made by the doctors after getting overwhelmed by the huge numbers of people was that most of the cases handled could have been treated a while back.
Dr William Masereka, a medical officer at the camp working with Bulamu Healthcare International, says majority of the hernia, tooth decay ovarian and cervical cancer cases could have been attended to before they advanced.
“But because people do not get basic medical services at health facilities near them due to lack of equipment and human resource, they choose to stay in villages and only come when such opportunities are available,” Dr Masereka says adding that the camp registered 700 dental cases and none of the patients presented with a tooth for cementing, but to have them extracted because they had decayed up to the gum.
Emmanuel Lubega, a dentist at Kyanamukaka Health Centre IV, says the facility has one dentist who is also not equipped. “We only offer extraction services yet we would also fill and clean teeth but we do not have what is needed.”
According to the National Health Policy, a typical health centre IV is supposed to offer minor surgeries. It is also meant to provide blood transfusion services and comprehensive emergency obstetric care and serve about 100,000 people. However, few health centre IVs are fully functional to carry out minor surgeries. Because of this, facilities refer cases which would ideally be managed at this level.
Sylvia Kayesu from Kabukongote in Ntuusi Sub-county, Sembabule District, says she cannot risk going for delivery at Ntuusi Health Centre IV because its theater is nonfunctional. “To avoid panic, I go to Masaka hospital where I know that I will have access to the theatre in case I fail to deliver normally,” she says.
According to the 2018/19 health sector budget framework paper, Masaka hospital registered 2,163 referrals in 2016/17 while in 2017/18, 660 referrals were received. As per 2018/19 planned output, the hospital expects to receive 2,640 referrals.
Edward Kabuye, the Masaka hospital principal administrator, says most of the cases received are mothers who need cesarean operations, cervical cancer patients who need radiotherapy, eye defect patients, heart disease patients and patients, especially those with head injuries who need CT scans.
But due to lack of some medical equipment and specialists to offer highly specialised medical care, he says the hospital cannot manage all the cases received. For example, the hospital has not had an ophthalmologist for the last six years.
“Cases such as head injuries for accident victims are not managed because we do not have a CT scan; cancer cases are also not managed both diagnosing and treatment, as well as eye surgeries and heart diseases” Kabuye says.
He adds that they normally refer such patients to Mbarara hospital (especially CT scan and eye surgeries) while cancer and heart diseases patients and other major surgeries are referred to Mulago National Referral Hospital.
But while many may afford to go to the hospital they are referred to, others are constrained by finances and lack care takers.
For example many cervical cancer patients who are referred to Mulago National Referral Hospital for radiotherapy fail to go and some simply come back to the facility and resort to palliative care while others go back home and wait out their last days with their families, according to
Dr Senyondo Gonzaga who heads the maternity department where cancer screening was integrated with maternal care.
Gerald Atwine, the Bulamu Health Care International president and co-founder, says his organisation has staged camps in different parts of the country but they have been overwhelmed by the influx of patients.
“This indicates that the health care system has a lot to do. We should stop looking at buildings as an indicator of better health services delivery. The buildings must be well equipped with medical equipment and labour,” says.
Uganda has continued to fall short of the pledge in 2001 Abuja Declaration, where African Union countries met and pledged to set a target of allocating at least 15 per cent of their annual budget to improve the health sector. But eight years down the line, Uganda has not increased the proportion. It is instead reducing it.
In 2016, Uganda’s budget allocation for healthcare was about 8.7 per cent, but it dropped by three per cent in 2017. Although she admits that there are gaps in funding, Dr Diana Atwiine, the Ministry of health permanent secretary, says the little funds received are put to critical areas, and offer the minimum health package to the population.
“Yes there is gap in funding but we are not the only priority. Government has other priorities and we take it in good faith. Uganda is developing and cannot have everything that is why we set the minimum health package,” Dr Atwiine adds.
Cost per citizen
Findings in the latest Annual Health Accounts (NHA) study by the Health ministry indicate that on average, government spends Shs3,000 to provide health care services per citizen in a month.
Asked if the government has left the burden to extend quality care to rural citizens to medical camps, Emmanuel Ainebyoona, the Ministry of health senior public relation officer says: “First and foremost, medical camps supplement government programmes and it is the ministry of health that clears them.”
Largely, Ugandans get health services from public health facilities. Findings in the latest Annual Health Accounts (NHA) study by the Health ministry, show that one of every two households seeks health services from private providers as opposed to 13.5 who go to public facilities.
Although there has been a marked quantitative improvement in Uganda’s health sector gestured by a rise in physical heath units, including in the country’s remotest corners, shortage of nurses, doctors and specialists, plus lack medical equipment has seen many people fail to get timely and advanced health care.
Uganda’s doctor-to-patient ratio is estimated at 1:25,725, with a nurse to patient ratio of 1:11,000. The World Health Organization (WHO) recommends one physician per 1,000 people.
Early this year, after receiving several complaints from previous camps where several preventable deaths were registered due to unqualified medical practitioners used, The Uganda Medical and Dental Practitioners Council (UMDPC) introduced new guidelines and pre-requisites, for organisers offering among others, surgical and dental services.
Organisers were tasked to have a plan for management of early and late complications including a plan for patients’ referral where necessary. Applicants are supposed to declare the purpose of the camp whether there is a research component to the camp and if so, the necessary ethical approvals provided by Uganda National Council of Science and Technology (UNCST) guidelines must be sought prior to starting the camp.
Also, a detailed report of the camp must be submitted to the UMDPC within two weeks of completion of the camp detailing the achievements of the camp, number of persons served, any challenges encountered and a follow-up plan.