Mulago CT scanner puzzle

By Flavia Nassaka

Patients, doctors say machine broke down; hospital insists everything is OK

As journalists, we often encounter situations that should be straight forward but become quite complicated for no clear reason. One such incident happened recently at the Mulago National Referral Hospital in Kampala.

We got information that the only CT scanner in the biggest hospital in Uganda had broken down and that hundreds of patients were stranded. People who tip off journalists often exaggerate. So we trimmed down the `hundreds of patients’ to `several patients’ stranded when we contacted the hospital Public Relations Officer, Enock Kusasira.

He assured us that the machine had not broken down. Rather, it had been shut down for maintenance and was already back in service. Satisfied, we rubbed the story off our register. That was on Feb.11.

But then, our sources kept calling and insisting the CT scanner was in fact out of service. We decided to check it out. One question we wanted answered was why the hospital was not willing to say the CT scanner had broken down. The second question was why Mulago hospital has only one CT Scanner. Is it very expensive?

A search on the Internet revealed that the cost of CT Scanners, like most items, varies depending on capability, model, and manufacturer. The cheapest was US$65,000 (Approx. Shs190 million) and the most expensive about US$300,000 (Aprox.Shs860 million).  Mulago Hospital has a 16-slice Philips MX16, which is a good quality medium range machine. Our sources told us it was acquired for about Shs2 billion. That quotation was more than twice the price of the most expensive machine. That did not surprise us. Somehow everything costs more in Uganda.

Next, we decided to check if the CT scanner was down or running. Soon we were chasing the story of an affected patient; Johnson Busobozi.

Busobozi, 32, was involved in a motor accident on Jan. 29 in which he hit his head hard.  Though he did not get visible head injuries, he was admitted to Kagadi Hospital in Kibale district for treatment of any possible injuries.  While there, his condition kept deteriorating prompting need for better medical care. He was transferred to a private medical clinic in Fort Portal. When he started losing memory the doctors recommended a Computerised Tomography (CT) scan of his brain and referred him to Mulago since no medical facility in Fort Portal offers that service.

On reaching Mulago on the evening of Feb. 06, the doctor in charge gave Busobozi’s caregivers the bad news. Sorry, the CT scanner at the hospital broke down weeks ago. The only option, he told them, was to go to a private provider.

Busobozi was rushed to Kampala Hospital, a nearby facility where he was charged Shs170,000. He was diagnosed with blood clots in the head. He received some treatment and he started to regain his memory. The doctors told him it would take time and discharged him.

Busobozi was lucky. Some patients who had paid for the procedure at Mulago before the machine broke down were demanding a refund with little success. Some patients who did not have extra money were sticking around the trauma unit and radiology department and hoping the problem will be fixed soon.

Meanwhile, we did some arithmetic work.  A CT scan procedure at Mulago costs Shs120, 000. One department, the Neurosurgery Section, orders between 10 and 20 CT scans every day. That is Shs1.2 million daily minimum or Shs36 million per month and Shs432 million per year from just one department. We concluded that purely as a business decision, Mulago Hospital requires and can afford a few more CT Scanners. In which case, if one was down, the patients would not be left desperate. Or, as a neurosurgeon told us, the patients would not have to resort to private hospitals.

According to medical experts, the CT scan is one of the top medical diagnostic developments. The scanner is a huge machine which about the size of car. It looks like a giant cave with a bed which slides in and out and very bright light.  The patient lies on the bed and the scans enable doctors to see real life images of internal organs without having to cut up the patient.  The CT scanner uses a computer that takes data from several X-ray images of structures inside a human body and converts them into pictures displayed on a screen for medical conclusions. This detailed information can be used to determine if there is a medical problem and its exact location. All these details are gleaned in just a few seconds.

Many private facilities like Mengo Hospital, CASE clinic, Nakasero and Nsambya offer CT services. But they are more costly than Mulago and range between Shs200,000 and Shs300,000. The only other government hospital with the CT scanner is Mbarara Hospital.   When we asked Dr. Asuman Lukwago, the Permanent Secretary in the Ministry of Health about the Mulago CT Scanner, he was apologetic. He said the ministry is aware of the crisis at Mulago ranging from old equipment and scarcity of vital equipment. He said the government was working to eliminate shortages and such issues will be a priority in the next financial year.

Meanwhile, the national hospital has since late last year embarked on major structural upgrades, after the African Development Bank gave out a US$ 50m loan for this purpose. Part of the upgrade is procuring medical equipment, which will include CT and MRI scanners.  That is the plan on paper. Hopefully, it will be actualized.

Unfortunately when the Independent contacted an official in the radiology department on Feb. 14, the Mulago CT Scanner was still down and there was uncertain about when the machine will be restored.