1 Aug 2011

Hospital sicker than the sick: campaigners say Ugandan maternal health care harming rather than healing

In 2009, the following story appeared on national newspaper. I was sufficiently outraged and I penned a letter to the editor. Please read the story and the letter to the editor that follows:
Residents march to Mityana Hospital in protest of the death of a mother and her baby during labour
Residents march to Mityana Hospital in protest of the death of a mother and her baby during labour

Hundreds of angry residents stormed Mityana Hospital yesterday morning, protesting the death of a mother and her baby in the labour ward. 

The crowd entered the hospital, attempting to lynch the health workers whom they blamed for the death of Sylvia Nalubowa, 39, a resident of the nearby Bussujju village. They also accused the medical staff of demanding bribes and not caring about their patients, and held them responsible for the chronic drug shortage. 

The demonstration caused all medical personnel to either flee or go into hiding inside the hospital, leaving dozens of patients unattended to. 

Health ministry officials said it was the first time in Uganda’s history that a mob has attacked a hospital. 

Nalubowa, who was pregnant with twins and was referred to Mityana hospital for emergency care, died at about 2:00am on Thursday after waiting for seven hours without being attended to. 

She had delivered one baby at Maanyi health centre but the second failed to come out. Thus, the health workers referred her to Mityana, the district hospital. 

Following the incident, a senior midwife and three nurses were arrested over neglect of duty. The four were supposed to be on duty that night. 

But the arrest was not enough to convince the residents that justice was being done. At 9:00am yesterday residents of Mityana started demonstrating in the town. 

They were joined by about 100 men, women and children from Bussujju, 30km from Mityana town, where the deceased came from. 

The deceased’s husband, Stephen Ssebiragala, did not join the demonstration but his relatives were present, weeping and sobbing. 

In the afternoon, some nurses resumed work after armed Police men were deployed to protect them. 

From the hospital, the demonstrators marched into Mityana town, carrying placards denouncing the medics. They demanded that all medics in Mityana be dismissed and replaced. 

The Police, led by District Police Commander Ben Mubangizi, drove the crowd out of the town to the outskirts. They went to Busimbi Gombolola grounds. 

The district LC5 chairman, Joseph Musoke, made unsuccessful attempts to address them. The crowd shut him down, demanding for officials from the health department to be brought to them. 
Later the resident district commissioner, Harriet Kagaba, succeeded to address the demonstrators, appealing for calm as the authorities would address their grievances. 
“The arrest of the four nurses is just the beginning. We shall do our best to ensure that the matter is handled according to the law,” she said amid cheers. 

The director general of health services at the Ministry of Health, Dr. Sam Zaramba, described the action by the crowd as “unacceptable”. 

“Whereas they were right to protest the health workers’ actions, they should not have attacked the hospital that they will go back to for services,” Zaramba said. 

He also blamed the negligence on the part of the health workers and promised to have their case referred to their respective professional bodies for investigation. 

Dr. Tom Mwambu, the president of the Uganda Medical Association asked the Government to raise health workers’ pay to improve services. 

He said that the doctor, being alone, could not be at the hospital 24 hours a day but after being called, he should have responded quickly. He blamed the nurse who insisted on being given cash. 

“The doctor will have to answer questions from the medical council to establish if he acted unethically,” Mwambu said. He said the action of the mob would scare medics from working in Mityana.
My letter to the editor
The gruesome death of a mother in labour in Mityana Hospital due to professional neglect is as unfortunate as it is common. In Uganda almost four hundred mothers die out of a hundred thousand every year due to pregnancy and child birth. That is equivalent to six busloads of innocent Ugandan mothers being condemned to death every year. That is outrageous; but, most of these mothers die quietly without any publicity.

The main causes of maternal death in Uganda are mainly uncontrolled bleeding, obstructed deliveries, sepsis, complications from abortions, and other so called in-direct causes like malaria, TB, and HIV/AIDS.
On this list, I must add perhaps the biggest enemy of expectant
mothers: professional neglect and cruelty by health workers. Most of these deaths are preventable if timely and accessible emergency obstetric care is made widely available in health units of every parish and sub county in the country.

I condemn the callous manner that the health workers of Mityana hospital displayed in handling this unfortunate mother. Such behaviours are contrary to the sacred ethical standards of medical practice. Perhaps this incidence should highlight the need for results-tagged incentives to health workers. Much as health workers clamor for pay rise, it must be based on adherence to ethical and quality of work standards on their part. Government pays you; you should not pretend to work.
Patrick Odongo

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