Dry medicine at Mulago

By Pearl Natamba

How do patients and their attendants avoid infections if they cannot find water to wash their hands at the nation’s top health facility?

It is easy, when you are in the casualty ward at Mulago National Referral Hospital in Kampala, to imagine that possibly all disease causing creatures; germs, bacteria, and viruses have been referred here too. You can imagine them crawling all over the bleeding wounds, in the dirty beds and unwashed bloodstained hospital linen. When you feel those disease causing creatures all around you, the urge to wash hands becomes unbearable. And that is when your real problem begins.

I was there recently, fortunately as a visitor not a patient. After braving the signature stench which seems like that of sweaty dirty clothes that had not been washed in a long time, I made my way into Surgical Ward3A. It is in the Orthopedics section of the Causality Ward of the hospital.

It was 10:30am on a fairly cold Tuesday morning. Patients; victims of numerous accidents, lay in agony in varied contortions on the floor on brown unfolded box papers that acted as mattresses. Used surgical gloves, tinted brown from numerous feet stepping on them, lay strewn all over the bare gray cemented floor.

The plastered swollen face of one of the accident victims caught my attention. The man dressed in a green blood stained shirt was lying on a bed with his hand bent grotesquely over his head. Imagining his pain made me feel unsteady. I stretched my hand to grab at the bed behind me in a desperate bid to sit. Before I could settle on the bed, I noticed something else that made me jump. The patient on this bed was covered in dirty blood-stained bed linen that looked like they had once been white but was on the way to becoming brown. I looked at my palms. I had touched the thing in a clear plastic bag beside the dying man that looked like bread but could be anything else. I desperately wanted to wash my hands.

When I looked at the bed next, it looked even worse as the beddings were more blood stained and the bed sheet was touching the dirty floor opposite where a very sick-looking, helpless patient that had on a dirty torn grey shirt and a stained brown trouser folded at its hems was lying cringed in a pool of what looked and smelt like urine. I was told he had fallen off the bed.

I could not take it anymore. I told the Customer Care Assistant who was guiding me through the ward that I needed to wash my hands.

Together we scoured the ward for some minutes with finding a water tap. Unbelievable, I thought.  How does a Casualty Ward in a busy hospital not have water and soap? I was becoming desperate. That is when I entered a place with a water tap. It was a rusted tap and dirty looking. But I was eager to feel the flow of fresh water on my hands. I wanted to be clean.  I turned the tap. It was dry, broken. It rotated lifelessly and swiftly; a clear sign it had been broken for some time. The Customer Care Assistant sensed my uneasiness.

“The tap is going to be fixed very soon,” he said, “and after the patients are transferred to other wards later on, this place is going to be thoroughly cleaned”.

I was only half listening. I needed to find water. Being a hospital, I was very sure there could be water in other wards. I turned to a man wearing a cleaner’s uniform.

“Where can I find water?” I asked, “I need to wash my hands”.

He hesitated.

“Huh, there is no other tap here,” he said finally, “You are going to move straight to the other ward where you will find another tap.”

As soon as I entered the Medical Ward to which I had been directed, I started a frenzied search for the water tap. I saw a few but all were broken.  Desperate, I decided to ask one of the nurses on the ward if they could direct me to where I could wash my hands. The nurse took me to a small room with cool air flowing in from a tiny open window. It had the usual tiny hospital bed on which other nurses were cleaning and arranging medical instruments. This room had a tap with water. Finally, I could wash my hands. I was happy even if I had washed without disinfectant. Then it occurred to me that not everyone visiting the hospital can come to this room to wash hands. Where do the others wash their hands?

That is when I decided to check out Ward 2C, the Pediatrics section of the Orthopedics Ward. It was clean compared to where I had been with no dirt on the floor. It also does not have water which I discovered after trying to open the only tap which was not fully wrapped with white plasters like the rest. I proceeded to the toilets.  One sink that had a tap was wet so I figured it had water. But it was clogged and covered with leftover food which seemed to have been left there the previous day plus a colorless small tin filled with very dirty water. I did not have the courage to turn the tap.

A Report on the deplorable state of regional referral hospitals was released on Feb.6. Mulago was not covered in the report because it is a national, not regional, referral hospital.

But the report noted: “Although the Annual health sector performance report 2009/2010 indicates that for the past five years, financial releases to the regional referral hospitals has been increasing from Shs 236 billion in 2006/7 to Shs 735 billion in 2009/10, the report for 2010/2011 gives a decline as a percentage of total government expenditure from 9.6% in 2009/2010 to 8.9 in 2010/2011 which is below the 15% target commitment to the Abuja Declaration. The 2009/10 Annual Health Sector Performance report estimates that Shs 1.5 trillion is required annually to deliver the Uganda National Minimum Health Care Package.”

According to the report, “The right to health is therefore an inclusive right, extending not only to timely and appropriate health care, but also to the underlying determinants of health, such as access to safe and potable water and adequate sanitation as one of the rights of a patient”.

When I asked Enock Kusasira, the Mulago Hospital publicist, about the water situation, he was defensive.

“The same way your water supply is cut off at your home, is the same way we are also cut off here at Mulago,” he said.

“I think you are just unfortunate to have come on a day when our water has been cut off,” he added.

Why does he assume the water in my home is cut off? In any case, my home does not get the Shs10.7 billion for water per year or Shs 30 million per day that Mulago spends on water according to its budget planners. Those were my thoughts.

Later when I contacted Chris Nsubuga, the National Hand Washing Campaign coordinator, he told me that maintenance bills, such as the water bill, are some of the biggest challenges hospitals face.

Still, he said, it is important for a hospital to have plenty of water in order to prevent easy contraction of infections including diarrhea, stomach complications, Ebola and cholera.