The changing face of Makerere University hospital

Kampala, Uganda | THE INDEPENDENT | Makerere University Hospital has received a major face lift despite the insatiable demands at the hospital. Dr. Josaphat K. Byamugisha, the Director of the newly refurbished hospital, says the renovation is a sigh of relief. Dr. Byamugisha, who is also a professor of Gynecology & Obstetrics at Makerere University says he no longer has to struggle each day with issues that came with unsatisfactory services and dilapidated buildings.

The hospital now falls under Makerere University Health Services which works jointly with other satellite clinics in all the university campuses and dental Hospital. Despite the closure of the university as part of the preventive measures against the coronavirus, the hospital has remained fully operational. Makerere University closed for 30 days effective March 20, 2020.

Dr. Byamugisha told URN in an exclusive interview that prior to the renovation of the hospital, the delivery of health services had become difficult and expensive to manage. “The diagnostic services namely laboratory, ultrasound scan and X-ray were being managed by a private company that had done so for more than 15 years. The complaints from the users and stakeholders had become recurrent,” says Byamugisha.

In 2016, Uganda Radio Network (URN) published a story showing the shocking state of the hospital, which triggered several discussions. In July 2018, Makerere University leadership agreed to transfer management of University health services to the College of Health Sciences, a move that has according to Dr. Byamugisha seen the University health services return on; “the road to recovery”.

“The Hospital has been reorganised and a triage unit opened a clear cut out patient department and lying-in ward marked out,” with University students, as its main clients.

How Hospital Units are performing

With an estimate of over 1.5 million Ugandans suffering from avoidable visual impairment, as a result of lack of accessible eye care services, in August 2016 Makerere University launched an optometry (eye care) with support from the Australian government and other NGOs involved in eye care.

Since the installation of new equipment, the hospital has been offering comprehensive eye care including; routine eye checkup, refraction, eye health slit lamp examination (anterior eye and fundus assessment), intraocular pressure measurement, Pediatric eye health and binocular vision services (examination and therapy) such as squinting eyes, treatment for amblyopia, as well as color vision assessment.

The hospital also offers examinations and therapy for low vision, manages eye disease and prescribes as well as dispenses spectacles among others. According to Dr. Byamugisha, the hospital seeks to install the missing diagnostic equipment including perimetry and fundus photography.

“In order to benefit the community to a greater level, we hope to conduct eye screening programs in the community so as to provide eye care services to all people and detect ocular disorders through screening the populations,” Byamugisha says.

HIV Counseling and Testing

Between 2018 and June 2019, Makerere Hospital working in conjunction with Makerere University Joint AIDs Program (MJAP) tested 5302 clients, majority of them students. And the number of HIV positive cases was 84 making 1.6% of the number tested.

Safe Male Circumcision

The hospital has been providing both hospital based and community outreach safe male circumcision since the campaign started. The Hospital circumcises 6000 people on average annually, according to statistics obtained from the hospital.

The hospital has according to Dr. Byamugisha increased the numbers of clients from close to 2000 patients annually to now around 5,800. The most common conditions remain malaria, minor injuries, Ear Nose and Throat conditions, sexually transmitted infections, dental problems and internal disorders.

Dr. Byamugisha attributes the increased numbers of clients to improved services at the hospital. He reveals that they have already started conversations with insurance companies to enlist the Hospital.

Laboratory Services

In previous URN reports, the laboratory services at the University Hospital had deteriorated as the outsourced firm M/S Crystal Holdings Ltd was reportedly inflating the costs of lab services. In fact, the 2016 Rwendeire Visitation Committee report noted that the laboratory services were grossly abused by requesting for unnecessary lab tests in a bid to inflate the figure billed to the University.

A case in point is on March 20th, 2015, where about 80% of the students who purportedly turned up underwent 11 tests including a patient whose chief complaint was itching of the eyes (allergic conjunctivitis). In a number of cases, a review of the patient files revealed that results for the numerous tests purportedly undertaken were not on file while all lab requests seen lacked clinical notes to guide the lab technician.

As a result, the Rwendeire probe found that there was absence of a proper system of internal controls to ensure that the University was actually billed for the medical services rendered to students in form of segregation of duties and proper authorisation with possible fraud.

When this reporter visited the Hospital, the administrators explained that it had transited from private management and was now fully managed with collaboration with the College of Health Sciences with coordinated tests carried out with the School of Biomedical Sciences Laboratories.

Milton Mugisha, a Lab Technician at the University Hospital says they have with the improved laboratory facility increased the number of tests for clients. He notes for instance that the hospital was able to test 20,781 samples and worked on 11,543 patients. From the lab statistics seen by URN, majority tests carried out were malaria, UTIs, typhoid and HIV.

The condition with the most positive tests was UTI with 50% of the tests being positive. Mugisha says they have obtained state of the art equipment including a three-part hematology analyzer used to conduct a complete blood count (CBC), chemistry and immuno-assay analyzers among others.

According to Mugisha, with the new equipment, the laboratory now has capacity to conduct several tests including detection of cancer, liver function tests among others.

Hospital Staffing

The hospital currently has 50 staff plus 6 volunteers instead of 74 workers that are expected to serve the facility. Although Professor Byamugisha says the hospital has an arrangement where several experts teaching at the University’s College of Health Sciences conduct specialized clinics at the hospital on intervals.

What hospital users say Obed Kwokuboth Jalmeo, a 2nd year bachelor of Education student and Guild Presidential candidate says the hospital has changed for the better but not yet the best.  “It has changed somehow from there being no Doc [Doctor] to you finding at least one.

From you finding totally no drugs to you finding some at least (though most people are often referred elsewhere because the drugs are still as limited). From not having facilities to prompt tests,” Jalmeo says. He adds that; “There’s therefore still serious need to utilize the monies paid for medical expenses to stock, create adequate space, etc.”

Emmanuel Opolot, another student went to the University Hospital in February this year to receive treatment. “From last year, there has been a change to me, though there are individual weaknesses in some people, generally there is a move towards positive change,” said Opolot.

Adding that, “The very last time I went there was to receive treatment, and I got the very best customer care from Doctor Buyinza God Bless him so much. Though I don’t know if they have improved their Lab presence on Sunday, it seems it is out of service practically on Sunday, if it is still so, it should be revised and worked upon.”

A student resident of University Hall who preferred anonymity however, says he has on many occasions got disappointed with the hospital services. “It’s just a building, nothing else,” he said. According him, the hospital services need to be stepped up especially in the night.

He recalls rushing a student who had a fractured shoulder to the hospital during the guild campaigns, only to be referred to Mulago National Referral Hospital.  “A lot of money (hospital fee) is collected but it seems it deals with minor cases like fever, cough and flue,” he observes.

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