At the front gate near the main entrance, a waste spilling cesspool warns of surprises awaiting a first time visitor inside Hoima regional referral hospital perimeter.
Once a model healthcare facility, faultless and immaculate, it has become a veritable shadow of its former self.
Residents are struggling for access to quality healthcare. This has been due to low funding, staff shortage, negligence by staff, and lack of supplies, coupled with low bed capacity. This has birthed a growing dissatisfaction among residents who wait for days to be treated.
“It (hospital) is worthy to be classed as an ailing healthcare machine, conditioned as helpless and desolate with patients,” says a visibly frustrated, Francis Ntegeka, a resident of Duhaga cell, a Hoima City suburb, who lost his wife in early April due to alleged negligence by the nurses.
The low morale among the staff and administrators permeates through a new style and modus operandi exuded from the ongoing strike of intern doctors.
The unexplained low budgetary allocation at this facility has also bred a taste of a strange culture of “to whom it may concern.”
This seems to have taken root during and after the COVID-19 pandemic, which disrupted health services at the hospital.
A diabetic patient avers that due to a shortage of doctors and other medical staff, the hospital managers do not keenly monitor the quality and efficacy of healthcare services.
“I was sitting there for three hours waiting for a dentist. There is only one dentist, and yet we are many in the queue,” Joan Aheebwa (not real name) said.
This is despite the fact that Hoima city is at a unique crossroads and overwhelmed by an increase in the number of patients.
“In just 24 hours we receive between 900 and 1,000 patients with a general bed capacity of 430 and the staffing does not equal this workload,” says Evelyn Achayo, the hospital’s senior nursing officer.
This is due to an increasing population as people flock the area in hordes to search for opportunities in the oil and gas industry.
Located opposite Boma playground in Hoima City, the hospital is one of the oldest hospitals in Uganda, dating as far back as 1935.
Initially, it was meant to serve a very small population at district level but in 1994 it was upgraded to referral status targeting Bunyoro sub-region.
Health experts say it is becoming too small to meet the health needs of the growing population.
The health facility is supposed to serve nine districts in Bunyoro sub-region; including Hoima, Masindi, Buliisa, Kiryandongo, Kikuube, Kagadi, Kibaale, Hoima City and Kakumiro with an estimated population of three million people.
However, parents come as far as Mityana, Kyankwanzi, Kiboga and the neighbouring Eastern DR Congo via Lake Albert which has stretched resources to the limit.
Supplies on hold as extortion claims grow
Blood transfusion services at Hoima hospital are poor with claims that medical workers sell blood at between sh100,000 and sh200,000 a litre, something the hospital administration has denied.
The oxygen tanks in the Intensive Care Unit (ICU) have remained un-replenished for two months since the oxygen machine broke down due to overuse.
The hospital authorities said they had by May 20, got a supply of 100 oxygen cylinders from Kampala but this could take them for only two weeks.
They said repair works will start soon, having got spare parts from Mbarara hospital to fix the refilling plant.
All supplies from National Medical Stores (NMS) have remained on hold since January 2023 including gloves, medicine, syringes, needles, anesthesia, and cotton wools.
“We only prescribe to the patients to buy medicines on their own,” a nurse added.
A patient confided on anonymity that in general patients are prescribed medicines to buy from private pharmacies that in most cases they cannot afford.
This particular patient was sent to a private pharmacy for medication worth sh70,000.
The doctors subsequently rejected and disapproved the medicines and ordered another set of medication.
“I was at a loss. I called a relative who lent me another sh70,000 to buy drugs and he now wants his money,” the source says.
Paul Ajuk, the deputy hospital administrator says that while they need sh6b, the hospital is availed a meager sh2b in annual budgetary allocation by the health ministry.
Even the water and electricity supply have in the past faced disconnections in case of delayed payment.
The toilets and the male ward are a living horror where many attendants fear catching cholera, typhoid, dysentery and gastro-enteritis while taking care of their loved ones.
The facility’s wards are not properly cleaned and the cleaners have not been paid for four months.
Occasionally they volunteer on a compassionate basis but effluent flowing from these toilets poses a serious sanitation dilemma.
Behind the children’s ward is uncollected garbage and overgrown grass where stinking odour wafts through the air.
In the children’s and other wards, mosquitos hold sway, as there are no nets to stop them.
Achayo said they made an order to NMS for the mosquito nets in 2020 but to date nothing has been done about it.
Negligence of dead bodies
One last glance at the labour ward and female wards, the day of an impromptu visit by Hoima City Woman Member of Parliament, Asinansi Nyakato on May 20, there were four dead bodies of delivering mothers.
They had just met their demise attributed to negligence and the ongoing strike by intern doctors over delayed deployment and pay.
“If we can lose four mothers in a day, it means we lose 120 silently per month and this could be out of negligence and Hoima hospital was ranked among the worst performing but the perennial problems have not been fixed,” Nyakato quipped.
The Hoima City female legislator was shocked to find wards completely unattended.
Some nursing school trainees operating the wards made incessant phone calls for their seniors who sauntered in moments later but had a busy day answering questions of poor service delivery from the said legislator.
Starving dog in the ward
At the doorway of the female ward, there was a dirty-looking and starving dog.
Staff say that it belonged to one of the attendants, which Nyakato said was a testimony to the porous boundaries of the hospital, which poses a safety hazard to patients, attendants, health workers, visitors and hospital equipment.
Cancer patient in pain
Tears rolled uncontrollably from a breast cancer mother. Her breasts are swollen to bursting point but has never been referred for further management.
“They keep promising to refer me to Kampala cancer institute. Nothing is done and I am here in excruciating pain,” she said.
Achaya said sometimes they delay referring some patients to Mulago hospital in Kampala is because of their socio-economic status, adding that under the pretext that they find it hard to sustain themselves there.
The hospital has one ambulance where relatives of patients are told to pay for fuel which is sh300,000.
The hospital needs a minimum of five ambulances to handle referral cases.
Nyakato promised to raise the matter in the parliament and asked the government to increase funding to the hospital.
However, she decried an insidious and growing conduct of medics putting people especially expectant mothers in situations where they have to pay.
Nyakato of the Forum for Democratic Change opposition party said the mothers are forced to go for caesarean section at a fee of sh500,000 yet such services are meant to be free.
Nyakato said the funding to the hospital must be increased if this growing population is to be served well.
Achayo, who promised to investigate the extortion and absenteeism claims by the hospital staff, said the hospital is understaffed where 60% of the health workers are students.
Beatrice Kabasiita, a female councilor for Central Ward in Hoima City, East Division Council asked the government to equip lower health centres so that Hoima hospital remains with only referral cases.
“The region has no health centre four – Kikuube and Buliisa are general hospitals and stop working at 5pm. Masindi has fewer doctors. We need to see lower health centres upgraded and equipped to health centre IV levels to address congestion,” she said.
The shining new buildings – an administrative block, Out-patient department and a maternity and operation theater ward were established in 2015. TAJ