On 19th Sept 2022 my sister checked in at Uganda cancer institute Mulago. Previously, we were admitted for over a week at Nsambya Hospital. The diagnosis was multiple myeloma, which many confirmed to us that it is treatable cancer depending on the level it is by the time it’s diagnosed. Personally, I had another relative who was diagnosed with the same disease a few years ago, he was rushed to India, and he was treated and has since declared cancer free. I will not derail much on the kind of service we got from previous hospitals but will only stick to what I saw, observed, witnessed and felt about a government self-autonomy institute- Uganda Cancer Institute-Mulago.
4th Oct 2022 night.
As I entered my bed at around 9pm, I called my nephew to update me on how my sister was doing, his answer in an usual tone was, I quote “ Ija oyerebere” meaning come and see by yourself. I shared with my wife the response I had received since she was near me, I requested her to dress up, and we leave to hospital. In less than 30 minutes we were in Mulago. Looking at my sister a million questions lingered in my head without answers the only thing I needed at that point was to see Doctors and nurses trying their best to save my relative-Alas, no medical personnel was on sight. Fortunately, among the visitors with us was a medical doctor. He rushed to the patient and started to assist especially with breathing issues like positioning the patient, placing masks etc. on this ward, there was only one nurse, and on the whole block there was no doctor. At least I checked on level 2, 3, 4, 5 and no doctor was on sight. Even the two nurses we spoke to confirmed that there was no Doctor.
The nurse on our level was overwhelmed and looked exhausted, tired, disgusted and lacked clarity on everything. Everyone was calling her, those that require extra fluids, those that needed her to stop drips, those that required injections etc.
Fast forward, our patient oxygen gamed and somehow, everything stopped working and we saw her dying. We rushed to level five and begged a nurse to assist us with a mobile unit which I think provides oxygen. This unit was supporting a patient who looked relatively better compared to ours, the nurse disconnected it form the other patient and gave it to us. We did all this at a terrific speed, not even Hussein Bolt could out pace me on the staircases both going up and running down. Our Visitor Doctor was happy to see us with the mobile oxygen machine. Soon he connected it and our patient was back to life but struggling. The mobile oxygen machine was running out of oxygen and the quick fix for us was to look for an alternative health facility. We mobilized for ambulance from city ambulance and sooner it was on ground and we headed to Kampala hospital. I drove very fast ahead of them to prepare Kampala hospital team. Patient was received at emergency point, straight for chest scan, later to ICU. All this in a blink of an eye. Doctors were there, nurses present, you would see activity after another.
5th Oct 2022 early morning, I lost my sister. Death is a given and certainly at one point all of us will die, the only drawn question is always how did he/she die? In my opinion and other relatives and friends opinions is that my dear sister died because of utter negligence of cancer institute Mulago team.
Why do I allege so?
Doctors’ absence from duty.
I did not know that in this age and era a facility like Mulago cancer institute can be without a doctor within the vicinity for duty not even an intern. This ideally would be the basic need. Even clinics in deep down villages adhere to this principal. A facility that celebrated 50 years of service and it calls itself a public, specialized tertiary care medical facility. Really, after 50 years of existence, the facility has no doctor present with over hundred in-patients. What’s the justification? Let patients die when both the patients and caregivers are satisfied that doctors and nurses did their best. How can a whole facility be without oxygen when the new 5th oxygen plant was commissioned recently to produce 70 cubic meters of oxygen which translates into 70,000 litres per hour?
Specialist doctors vending services.
DR O K M ( being his initials) is a DR at UCI-Mulago. The same Dr was allocated to us while still at Nsambya. When we transferred ourselves to Kampala hospital, the same Doctor was called at night and he came in the morning only to find my sister dead. I wondered why a fully employed government medial officer well paid would vend his services to more than 5 medical facilities? Ideally, I expect a government worker to work at least 8 hours per day or 48 hours per week. Outside this, government is being cheated. This is broad day robbery. In addition, from what I have observed over time a few Doctors especially the so-called specialist provide their services for 8 hours a day. Productivity doctor by doctor should be measured. The government is losing a lot of money through these doctors. They even earn a lot. URA should interest itself on many specialized doctors. They earn millions every months from different medical facilities. There could be some sort of tax evasion especially PAYE and income tax. Employment Act 2006 and the subsequent amended Acts are very clear on how many hours, days a +n employee ought to work. Ref: Employment Act Article 5 1-9.
Health Service Commission Act, 2001-Act 15 of 2001-What does it say?
I picked a few lines in this Act and evidently, the Doctors and administrators of UCI neglected their duties by either omission or commission. I looked through what the Act requires the health officers to do. I picked a few lines as below,
- Responsibility to health unit or place of work
A health worker shall abide by rules and regulations governing the place of work and shall conform with the expectations of the health unit and strive to fulfil the mission of the institution.
30 (9) A health worker shall not abandon a patient under his or her care.
- (2) A health workershall ensure that no action or omission on his or her part, or within his or her sphere of responsibility, is detrimental to the interest, condition or safety of a patient.
The look and feel.
The place stinks, some of the equipment in use are rusty, and the whole arrangement is messy. It is not the cancer institute known and desired. At night especially on level three, people (caregivers) sleep at reception and the whole area becomes smelly. Washrooms in place are not enough; the cleaners clean only at night. In fact, one risk getting infection from this place. A cancer patient is always fragile, immunity down; they deserve a well neat and clean environment. Sanitation is so bad. On scale of 1-10, I would give CIU a core of 2. If CIU is struggling with sanitation, how will they give required medical services?
Visual gaps in leadership.
Top leadership must reengineer themselves. How can a 5-floor hospital with critical patients be without a doctor or doctors at a certain Time T? Some questions are hard for us to answer. How do you track the duty roaster? Do you have a risk and complaint unit or person? How do you evaluate that scheduled doctors and nurses worked? I can never forget that night. I do not even want to pass in Mulago compound. Its un imaginary that whole facility like Mulago cancer institute had no Doctor on duty. A few days before this incident, one night, we called a doctor who was on duty but had absconded. We needed his assistance, on call, he told us he was far, we offered to pick him, he said even the car cannot reach where he was, we promised to pick him on boda, he chose to stop picking our calls. A doctor who talk oath?? This is a sign of non-functioning leadership, systems, procedures, processes and logic and common sense.
Way forward
Install electronic monitoring tools, which will ensure Doctors and nurses, adhere to roasters. In security, there is a tool called guard patrol monitoring tool, where a guard on duty touches a guard point every after one hour. A report is auto generated on the guards performance during that shift. ED and your team fold your selves and come on ground at different times especially weekend and night times to see if the staff are on duty. Leadership calls commanding from front not rare.
Robin S . Sharma once said, Leadership is not about executive position or title. It is about connection and influence. At its highest, leadership is all about adding value to the world and blessing lives through the work you do. Is this what you doing the CIU top leadership?
As I end this article, far from conviction, my sister would have lived more days, months, or years. Extreme negligence, absenteeism contributed to her death. For us as relatives and friends, we demand satisfactory explanation including route cause analysis and way forward on how this incident will never happen again to any other patient.
Dear sister, rest in peace. You are dearly missed and forever loved.
Samson Tinka
tindsam@yahoo.com
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