This is what we must do to rescue our healthcare!

Women waiting to deliver at Mulago’s labour suite

By Bwanika Nakyesawa Luwero via UAH forum

When growing up in a medical family – I remember when Medical Doctor Samson Bbabbi Kiseeka arrived at one of the health center facility unexpectedly – it was a chaotic scene as all medical workers and support staff started running up and down whispering Dokita Kiseeka yazze (it is MD Kiseeka visiting).

Uganda Medical system can be rescued – and this is what happened 1960- 78 or ought to be done

a. Resurrect regular medical facility Inspection by the Ministry of Health Inspection Unit. These inspectors must have a list of items listed they have to look at. That form must be returned every month the an independent inspection team – i.e. Accounting General strict not MoH

b. Resurrect regular medical worker transfers. All categories of medical workers MUST not work in any single medical facility for more than one year. Ministry of health had a transport system to transfer medical workers. This too meant that all health facilities had houses for medical workers. A letter for transfer came from Kampala.

c. Outlaw patient – relative support from all healthy facilities. This implies the patient will solely be attended to by qualified medical workers only. This is the norm world over and it will also reduce on corruption where relatives have to pay for services rendered to patients in public medical facilities.

d. Private medical facilities should strictly be regulated – that is they should meet all world standards. Medical workers must work in a form of cooperatives, instead of turning the scared medical profession and facilities into money making facilities.

e. Resurrect medical equipment manufacturing and research – TAMPECO. All health facilities must order through such an entity.

f. Out-law foreign material likes clothes, bed sheets, mattress not approved, outside cooking at health facilities by the MoH from all medical facilities. That means MoH must provide patient cloth , workers uniforms, badges,food etc.

g. Turn regional hospital into teaching University hospitals

h. Lower medical staff (nurses, medical officers) salaries should be increased to a living wages. But ethic first.

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My sister died of HIV/AIDS and the govt could do nothing for her!

By George O.Pacu-Otto via UAH forum

On changing or reforming the healthcare system in Uganda, I have total loss of confidence in the NRA doing it. I am not going to talk about the corruption and shenanigans that go on everyday. What I will do is to repeat the tragedy of my own sister, who died of AIDS in 1986. It was her fault that she got HIV, she was only 19 years old. But throughout the time she battled with the disease, the healthcare system was not there to support her. The family quite often had to buy drugs, some totally useless. Towards the end of her life, she was not even admitted to Mulago Hospital because they wrote her off, so she spent the last weeks of her life in my brothers home in Nakulabye, being fed on a drip by a sister in law who is a nurse. Eventually it was my brother who pulled the drip off and said let her go, she has suffered enough.I had lost another sister before who was murdered by NRA soldiers in Dokolo, but she is not the one I focus on.

AIDS Patient in a hospital

My burning and continuing anger against the NRA regime is why my young sister, who I loved, would be turned away from Mulago hospital, denied medical help and die at home, with just a nurse caring for her, without any medication of any kind.So I look at these issues politically.It was the neighbours, baganda people, who comforted the family and assisted in repatriating her
body to Dokolo for burial. That day when I arrived in Nakulabye when my sister died, most of the mourners were Baganda neighbors. I will never forget that .

What was the purpose of NRA coming into power if they can not provide even the very basic care for a young girl who was dying? Why would a national referral hospital turn away a critically ill patient? Why should my sister have died at home rather than in the care of the medical services?

That’s why I have so much contempt and indeed hatred for this NRA regime. May be other people have better examples , but permanently my hatred of the NRA became cemented that day when I rushed from London and saw her in her coffin, serene and beautiful and as lovely as we used to play around together as children , but she was dead.

We need to have a national democratic revolution in Uganda. We should never again have millions of people going through the trauma that I have gone through.

Guerrilla governments in Africa have failed in social services

By Simon Peter Okurut via UAH forum

I think the guerrilla governments in Africa have failed in social services delivery yet Cuba for example was/is able to serve its people very well.

To prove that observation, at 5;10 a.m.this morning, I listened to a BBC documentary on the state of health services in Ethiopia. The health services in Ethiopia are more sick than the sick Ethiopians, to say the least. The BBC program presenter interviewed medical students about their concerns and 80% of them planned to leave Ethiopia immediately they graduate because of several reasons including poor pay ($300/month), lack of facilities, overcrowding in hospitals and too many students in medical schools about 30 times the original planned number with many sitting on the floors when attending lectures, lack of further studies etc. Practising doctors prefer to work in urban areas because at least they can “moonlight” to supplement the meagre pay. One doctor decried the poor services in the main hospital ( their Mulago) where in one ward, there are only 11 beds for mothers delivering yet they admit over 50 per day so the rest just deliver on the floor and this doctor says that they helplessly watch patients die because of lack of nearly everything. Next the minister of health was interviewed who said that they are trying, that their priority is on primary health care which he said would reduce the number of those seeking treatment; and that the problem is compounded by doctors who leave Ethiopia for greener pastures elsewhere especially in eastern USA where there are more Ethiopian doctors than the total number of doctors in Ethiopia and they receive a salary of not less than $5,000/month. In his view he wanted the US to pay Ethiopia $200,000 per one Ethiopian doctor employed in the US since it costs the US government that amount to train one doctor. I failed to see his logic, at least if he had proposed the US to pay the equivalent that Ethiopia had spent training that one doctor, it would have some good argument. I was surprised to hear Ethiopians decry the poor health services now, and those interviewed calimed that same services were better some time back.. This revelation made me turn on my bed terribly wondering what curse had befallen Africa. I wondered how governments led by visionaries can fail to foresee shortages and plan accordingly in order to avert the crisis.

This is exactly what happened to Uganda when Idi Amin chased non-citizens (Indians), the government proceeded to allocate the well stocked shops to soldiers and those sympathetic to the regime; slowly but surely, the shops became empty and emptier and by 1978, most shop counters/shelves were filled with bananas, banana leaves or kabalagala with many shopkeepers yawning and sleepy early morning.

While we can suggest good ideas that could improve the social services ( medical services) in Uganda, I think the first thing we should do is to get the government directly involved by it spearheading the discussions so that we are sure that the policy makers and implementers are all on board and are ready to move forward. We need to engage various stake holders so that a strategy can be developed, otherwise none of the brilliant suggestions can be implemented or even discussed. I am not suggesting that we leave it all to government, no, what I am saying is that we need government to be a participant in the discussions so that whatever is agreed upon is put into practice; for we cannot achieve much without the government’s participation since it (govt) has more mobilization groups/resources.

Leaders should ensure that institutions are developed, strengthened and allowed to be independent. What you are talking about qualified ministers is the tendency to depend on individuals which has caused failures. Obviously, it was Idi Amin’s mistake to give out property to people who did not own it in the first place and the policy of sending non-citizens was wrongly done/implemented:this should have been in phases while local people were being trained to take over.

It would be a mistake to expect any president to know everything under the sky! And this is exactly the problem we face; our leaders assume that they know everything and when challenged, they get jittery. Politicians’ role is merely to oversee work done by technocrats. There are many ways of monitoring developments in constituencies not necessarily being there physically, though NRM government has found pleasure in dishing out millions of shillings to MPs during elections for “monitoring developments” in their constituencies some of which were abandoned for nearly 5 years!

Kampala Politicians and leaders aren’t bothered about our health!

Breast Cancer patient Jessy Acen, 30, is examined by Dr. Victoria Mwebe,

The habit of using polythene bags to cook food (Kampala is a model for Uganda) might be one of the causes for both cancers and neurological diseases, which are becoming rampant in our communities.

For motorised gas fumes – I know for a fact that they kill very quickly and quietly. I did extensive research about the same among mothers living on a heavly motorised street in Europe.

Unlike in Europe/USA cancers appear to be among lower age groups. We need a map of the population affected.

In half a year, I know more than six people who have either died from stroke or gotten paralysed! It is terrible and Ministry of Health and Environment appear not to be concerned. Those perishing in cancers we only hear of high profile who seek money to go to Nairobi or India.

The deaths and disease prevalence, can’t be a coincidence. Of course there might be a mechanism generating those two problems – I suspect high on the list being environmental pollution (VOC) and second excessive use of pesticide/herbicides.

The conditions are very bad given the fact there are dense population in filthy dirty town slums everywhere.

More threatening is what becomes of the people who acquire these diseases and then pass them on to their children as encoded genes?

Prof. Emeritus Calvo of Molecular Biology has told me that the next epidemiological concern in Uganda if not carefull will be genetic diseases – and getting therapy for these diseases might prove cumbersome as parents are now passing on cancers to their siblings as encoded genetic diseases!

I had decided not to write more about the subject. But then I remembered meeting Rwandese students who had come to Uganda, specifically to study Kampala environment. All of them were chemistry graduates as I discovered later.

They collected samples of soil and water and upon laboratory analysis, the discoveries were shocking to them. Indeed one of them went on to write a book. Fascinating so, some of these students, initially doubted their government’s stance on environment but by the time they left Uganda, they had become willing converts and unflinching disciples of Rwandese government urban and environmental policies!

Well for Ugandans it is business as usual, let us sleep on.

Now there is a high level of cadmium and ammonia (ammonia water) in all Kampala spring water. And we are increasingly having chlorinated water due to heavy Lake Victoria pollution! Can you imagine heavily polluted water springs? Reading from the causes, it is apparently clear all Uganda towns are affected in exactly the same way.

Kampala is a double tragedy.Once I suggested that Ministry of Health declares Kampala a poisoned region, unfit for human habitation so that as such funds could be committed for a #special status clean up#. Well my arguments were not politically threatening and as such irrelevant.

The burden as Prof. Emeritus Calvo asserts, is on the future generation genetic defects children and health issues that will emerge then!

Once again the poor picks the bills as usual as the rich head to India and South Africa riding on the poors back.

Bwanika Daniel via UAH forum
(B.Sc. Environmental Sciences – Linköping University Sweden)

This is why Cancer is rampant in Uganda now!

Only 25% of children with cancer complete treatment

Forumist

A childhood friend who has been working with government here, passed away instantly after he was found to have cancer, last friday.
He has not been sick and I talked to him just a week ago but instantly fell ill and died shortly afterwards! This the seventh person I have know closely, in six month who has died either of cancer or a stroke.

Data from Mulago shows that;-

a. Cervical Cancers as other cancers are remarkably increasing (VOC air pollution particulates and other causes)

b. More people are dying and paralysed from neurological diseases – stroke (may be chlorine in water?)

c. Kampala temperatures have risen from the average of 18 – 22 degrees Celsius to between 27 – 30 degrees Celsius today, indexically serious implication for Uganda as a climate, vegetation region.

d. Severe wet and dry seasons, as we recover from February , March dry spell/season that has seen food scarcity pushing food prices up, crops planted during April are being destroyed by unpredictable torrential rains similarly causing food scarcity pushing food prices up.

e. Severe coughs flu and burning throats, asthmatic diseases among children – result of sulphur dioxide in Kampala City air

Solution:

The Blue green Algae in Lake Victoria, first and foremost survive and depend basically on two nutrients; Sulphur and Nitrogen compounds. The question is where do these two compounds come from?

a. There is atmospheric sulphur but not in sufficient amounts which can pollute the lake

b. There is sulphur and nitrogen in food we eat, like beans and maize – the concentration are high to pollute the lake if let us say latrine content are released into the lake.

c. There are very high concentrations of sulphur in gasoline like petrol and diesel. Motor vehicles burning make it even more concentrated and very unstable resulting into complex compounds. In fact, if one is quite observant sulphur and nitrogen concentration in the city are so high to such an extent that if one is new to Kampala, s/he will chock on this sulphur gas.

The only way therefore, to save Lake Victoria is through, eliminating the sources, high level of motorized concentration into the city. The city which is hills and valleys allow gases to hang over Lake Victoria in both dry and wet seasons.

It will be near miracle to rescue Lake Victoria. Every single day that passes the Lake is continuously polluted since government action is very slow. There is need for pragmatism.

Daniel Bwanika via UAH forum

Gay oral sex can give you worms: Museveni

With all due respect to His Excellency, I think he was terribly wrong about the role of the mouth – that gadget has as many uses as a computer. It simply shows how he is living in another century and how many things have changed since he gained power. In reality, if M7 kissed Janet in public, Besigye and Amana would be history because he could get an unprecedented number of votes! Not with the many people who believe that his marriage is sexless and dysfunctional.

I use the mouth for the following:
– PowerPoint Presentations – most of my income now is tied strongly to my ability to speak
– Expression of disdain – in a situation where I cannot voice my disdain, I use the mouth and eyes to send a strong message of ‘don’t mess with me’
– I use my mouth and vocal cords to send a tirade of words or to jeer at those who malign me
– I use the mouth to make faces and entertain my little boys
– U can use the mouth to point
– I often whistle to myself when happy or bored or when there is a tune in my brain

A mouth is also used for expression, convincing, castigating, entertainment, fighting, smocking, smuggling, inciting, advising, consultancy, education, vomitting.

If only people worried about oral infections/cancers & were just as concerned about more serious & burdensome diarrhea related illnesses & deaths whereby efforts such as boreholes in constituencies held by so called MPs would help. Worrying about attributable death risk of oral cancers etc is searching for a straw man… Something politicians have been successful in drawing an easily diverted & uninformed population to…I’m amazed how many people become excited about relative non-issues while they meekly head towards some more serious impending health & environmental disasters.

H.O

In Uganda, the Uganda police is the only effective ambulance service!

University Hospital in Uganda

There is a lot of wastage of life due to these bogus health systems, and leaders who are selfish. The irony is that while it is the peasants who suffer most our leaders are also not immune to the stupid health systems they’ve set up – as in the case of Bingu wa Mutharika – a man who one time worked for the World Bank.

What makes African leaders so myopic and selfish when they assume power? The funny thing is that ‘individualism’ (the highest form of capitalism nurtured by the likes of Margaret Thatcher) results in creation of an elitist middle class that has too much money they do not know what to use it for – and one of their indulgences is chronic over-nutrition, sedentariness, money related stress and obesity – all these are a good recipe for a heart attack! But can our health systems handle the increasing burden of Non-communicable diseases, when even Panadol is a luxury in Primary Health Care facilities?

A “peasant” in the UK will get a heart attack, and he or she will have a mandatory trained paramedic crew get to him within the govt targeted 8 min on board with a defribrillator. He will also have an ECG telemetry monitor that will relay the ECG to a cardiologist to the designated coronary care Unit by bluetooth technology.So if there is need for intervention its in minutes or an hour at least.Compare this to our system, and you will understand why Abbey Semuwemba, George Okello, and others in the UK don’t want to move their families permanently back in Uganda.

Compared to UK, In Uganda, the Uganda police is the only effective ambulance service because at least they try their best to rush injured persons to hospitals – albeit on the back of a pick-up, their necks twisted, bleeding, with no first aid measures. All those at the brink of death end up dying anyway. I wish our leaders would focus on building a system, rather than the reactionary measures.

In 2012, Uganda hosted the IPU. The theme was on maternal and perinatal mortality. Alas! You can all see what the bald and wig heads discussed. Went off topic.

In Uganda its to be better to be a teagirl than to be a medic or teacher. KCCA reviewed its salary structure. Mbu, the lowest paid person, a tea-girl, gets 1.2 Million per month. However, there was only one exception – Health workers and teachers will not be entitled to this salary structure – mbu ‘it will destabilize the economy’. How can we have such a mindset! Is the input of a health worker and a teacher that much less important than that of a tea-girl. Is the government serious about social services? I think we have parasites, prostitutes and irritants instead of leaders. How many macro-economic mishaps have been bred through mismanagement, corruption, poor planning etc, all the while telling the teachers and health workers to be patient.

In almost all government hospitals, every Medical Officer has had to do a caesarean section using the light from a Nokia telephone – because there was no fuel in the generator. Dr. Obote constructed these hospitals in the late 60s and early 70s. He might have been another bogus leader, but at least these structures are there. All are is a pathetic state of disrepair, while billions are spent on reactionary programs that have no results. None of these hospitals have a reliable water supply, yet at the time they were constructed, they each had a water supply unit – the water pumps have broken down, and nobody is interested in their repair. The only thing they keep blubbering is that the Basawo are stealing drugs – are drugs the only ingredient to a health system, stupid.There are no drugs to steal. No anti-Kochs and no ARVs. Have they been stolen by health workers? Its a gimmick to cover up the lack of delivery.

There’s an extortionist team from state house traversing the country arresting petty drug thieves. Everything leans towards political gain but the reality is different. The real drug thieves are white collared and the president knows them from way back,they prop his government. They arrest doctors if they think you support FDC or Besigye.

Most hospitals under Obote and Amin had a hospital tailor. All doctors needed was to buy a roll of cloth and he would make the theater linen. Now these tailors have been replaced by contractors, who deliver more bogus items at 10 times the cost. The same contractors who constructed bogus theaters in Health Centre IVs. If I had the means, I would slap the Prime Minister, Amama Mbabazi. But the last time a man went over his fence to slap him, the man ended up 6 feet under, and Nina Mbabazi defended this action on UAH using all her brain parts before she left the forum.

I onetime saw on TV Police rescue at an accident scene at the crested towers round about, a poor woman with a broken leg was lifted like a hip of ” kasasiro” meaning Police can not even afford a stretcher on their patrol cars!!!!! Ambulances making noise around town without a paramedic or even the lightest first aid equipment!! Then you hear leaders moving around telling the world that it is the west that is keeping Africans backward! Our leaders are worse than the colonialists! that the reason I despise the Pan African movement which destroys what is African ( kingdoms) and puts in place nothing apart from rhetoric,chest thumping, wolokoso

Until Ugandans recognize and acknowledge that a good health system is the key to economic prosperity, then the rest is down the toilet. Pay the health workers what the rest of WHO does, good governance, respect the law of the land ,and cut down on those bureaucrats. Oh! Sorry I was just dreaming.

It seems to me all African leaders except a few are actually extra-terrestial,coz what they are doing shows as if one day they wil run off with all their loot to another planet where they came from!and they call themselves pan Africans,SHAME ON THEM!

R.JABENDO
USA

The tragedy of my own sister made me hate NRA/M Forever!

By George O.Pacu-Otto via the UAH forum

My friends,

On changing or reforming the healthcare system in Uganda, I have total loss of confidence in the NRA doing it. I am not going to talk about the corruption and shenanigans that go on everyday that say they can change, or even those who are supporters of the NRA.What I will do is to repeat the tragedy of my own sister, who died of AIDS in 1986. It was her fault that she got HIV, she was only 19 years old. But throughout the time she battled with the disease, the healthcare system was not there to support her. The family quite often had to buy drugs, some totally useless. Towards the end of her life, she was not even admitted to Mulago Hospital because they wrote her
off, so she spent the last weeks of her life in my brothers home in Nakulabye, being fed on a drip by a sister in law who is a nurse. Eventually it was my brother who pulled the drip off and said let her go, she has suffered enough.

I had lost another sister before who was murdered by NRA soldiers in Dokolo, but she is not the one I focus on.

My burning and continuing anger against the NRA regime is why my young sister, who I loved, would be turned away from Mulago hospital, denied medical help and die at home, with just a nurse caring for her, without any medication of any kind.

So I look at these issues politically:

What was the purpose of NRA coming into power if they can not provide even the very basic care for a young girl who was dying? Why would a national referral hospital turn away a critically ill patient? Why should my sister have died at home rather than in the care of the medical services?

Thats why I have so much contempt and indeed hatred for this NRA regime. May be other people have better examples , but permanently my hatred of the NRA became cemented that day when I rushed from London and saw her in her coffin, serene and beautiful and as lovely as we used to play around together as children , but she was dead.

We need to have a national democratic revolution in Uganda. We should never again have millions of people going through the trauma that I have gone through.

George O.Pacu-Otto

SIMPLE STEPS TO AVOID KIDNEY PROBLEMS IN UGANDA

Ugandans are suffering from kidneys and yes we need to treat them, but we need to question ourselves why they suffer from kidneys that highly. It is the food we have been brought up eating, we need to change our diet or we will continue to poison ourselves. I have gone after The Matooke diet for it is mainly water, but Matooke is so high on potassium which goes after kidneys. Now look carefully at what has so much potassium, Matooke, Gonja {or plantain} Amenvu, so all those classes of bananas. All yams including Amayuuni, kyetumula Lumonde Irish potatoes, all that you are sucking into your body is massive potassium, and these are the foods we eat day in and day out. To eat health food you need not more than a single banana a day, but my God a Ugandan to eat a meal he eats 5tons of Matooke in a single sitting, just how much do you poison your kidneys? So all the foods I have listed have to be taken with very small amounts when we in Uganda use them as daily main course, you must end up with high numbers of kidney problems.

Another thing we need to cut very low is beans, they have just too much iron that no intelligent person can eat them that much yet we also eat them.

Lastly let me go on medication, many Ugandans especially women use Advil for pain relief, and to tell you the truth Advil works miracles, women that get cramps with period use Advil, and in every house drawer there is a bottle of Advil. You need to realize that it is a bad medication for it must be processed by your kidney to go into your body, stop to use Advil if you need to put a break on your kidneys. What you can use that is safer to your kidneys is Tylenol for it is not processed through your kidney.

There are many steps we can chose to follow that are accessible in our means to cut down the numbers of kidney problem, but changing a Uganda diet must be a priority out there, for our combination of foods we eat is a cocktail of poison.

EDWARD MULINDWA VIA THE UAH FORUM
CANADA

A DIALYSIS MACHINE IS IMPOSSIBLE TO MAINTAIN IN M7’S UGANDA

Members the profit on medical machines of this capacity is usually recovered by the seller through maintenance and supply of materials needed to efficiently run them.Mulago hospital has many equipment which are either not working efficiently because they are not maintained or calibrated on schedule or are run by technicians or physicians who are not well equipped through training or have never had enough experience to run them.

You just don’t plug a person on a dialysis machine and clean up their blood like you just vacuum dirt from a carpet. The care of a patient on dialysis evolves a team of nurses and physicians, involves several lab draws and monitoring, many hours on machines and you can kill a person on a dialysis machine faster than their failed kidney.

So setting up a dialysis unit needs more preparation than many envision, however it is crucial that the government comes up with a viable plan because this is desperately needed. Lets also remember that many clients that go on dialysis have hope of getting Kidney transplants so those who plan for this kind of center are better of having a transition plan along these lines otherwise it means a life long life on dialysis. So depending on how many patients can be hooked on a machine per day and it takes hours to go through the cycle depending on your markers in blood and probably three or four times a week you figure out how many machines might be needed, obviously not one.

If I take an educated guess it might cost about $4 dollars per treatment in maintenance of the machine, minus cost of the doctors , nurses and other members of the team and cost of labs. If I pick a number out of the blue all those cost included not forgetting electricity cost you might be looking at $15 dollars per treatment (day) in Uganda.

Sometimes you can easily get a car that is cheaper than the cost of its yearly maintenance,insurance and gasoline but usually that’s an old car. But then a new car in combination with a bad or drunk driver or someone who has no licence to drive can easily lose its value as soon as it hits the highway. So I hope who ever does the math factors in all this.

Almost everyone who is trying to address the issue of Uganda’s health care asks the wrong questions. I said before about three years ago on this forum and I repeat my self I would not put a dollar more in this system as it is. Without rebuilding the whole foundation of our Health system all the money you pour in goes to an endless pit and you will never have anything to show.

I keep away from health care discussions that don’t discuss the real solutions, buying a Kidney dialysis machine now is no different from buying a plane when you don’t have enough runway to fly it off unless you have the capacity to modify it.

The roots, how deep they go, how much water they receive will determine the size of the trunk, which will determine the number of branches, which would determine the number of leaves, which would determine how many fruits a tree will have and also determine how many people can enjoy the supply it provides.
Build a strong foundation, and all these machines you are talking about will no longer be fantasies. For those who cant figure where to begin, get all your kids registered for identification cards.

Dr. Edward Kayondo, MD via the UAH forum
USA