Earlier this week, a 36-year-old man employed in Adjumani, Northern Uganda, traveled to Masaka for burial.
Musa (not real name) has a history of fevers and arthralgia (pain in joints). After the burial, Musa was admitted in hospital with malaria and typhoid.
He was given artesunate and ceftriaxone (medication used to treat malaria) without improvement.
Musa was then presented to IMC Entebbe with dry cough, chest pain and dyspnea. His oxygen level, or saturation (SpO2) was 82% and had coarse crackles bilaterally.
Musa did not have fever and was not known to have a history of chronic respiratory disease or other chronic diseases.
The patient was isolated and put on oxygen. IMC Entebbe contacted Covid-19 response team at Entebbe Grade B Hospital which said it’s operating at full capacity hence unable to take in new patients.
IMC Entebbe contacted an official at Uganda Virus Research Institute (UVRI), who agreed to take Musa’s sample and run it through express as long as the patient was transported.
The samples were taken but IMC Entebbe got stuck with Musa for hours before being advised by Entebbe Grade B Hospital to transfer the patient to IHK, Namuwongo.
IHK, which is affiliated to IMC, rejected Musa.
IMC then called City Ambulance which agreed to take Musa to inpatient hospitals, all of which reject him upon hearing that he had pneumonia and was oxygen dependent.
The hospitals (Nsambya, Rubaga, Mengo, Kisubi) said they could only take in Musa if he had a COVID-19 certificate showing he was negative.
City ambulance decided to transfer Musa to Kiruddu Hospital as Mulago could only receive patients with positive COVID-19 results not pending ones.
Kiruddu said their isolation for inpatients was full. They turned back the ambulance. IMC returned the patient to Entebbe Grade B where they pleaded for space from a one Dr Nsereko who heads the Covid-19 taskforce there.
Dr Nsereko finally agreed to give Musa a bed. City ambulance returned from Kampala and put the patient at Entebbe Grade B Hospital.
Musa, who appeared at IMC at 9:00am, gets space in Entebbe at 8:30pm, his oxygen level is 79%.
Another patient, Peter (not real name), reported at Novik hospital in Kampala at around 5:00pm with respiratory distress. He had all other signs of Covid-19 symptoms.
Having no isolation unit at the facility, doctors organized an immediate referral process to Mulago hospital.
At Mulago, the ambulance team was bounced to Kiruddu which rejected the patient.
The ambulance team consulted Uganda Healthcare Foundation (UHF) which advised them to take Peter to Naguru and confirmed that they had secured an isolation unit for the patient.
The Naguru team rejected the patient upon arrival of the team and his family.
Since it was approaching around 1:00 am, the family had lost hope and requested the team to drop them back to their home.
The team which had left Norvik hospital at 6:30 pm, returned after midnight.
This sheds light on challenges faced by hospitals as the country struggles to come to terms with the effects of the COVID-19 pandemic.
“The protocols are going to have to become significantly more streamlined if they are going to manage a full blown outbreak,” said a doctor who preferred anonymity to speak freely.
Take COVID-19 seriously
However, this situation also is a reminder to the public to take the COVID-19 prevention guidelines very seriously.
On August 20, Director General of Health Services, Dr Henry Mwebesa instructed the Directors of private hospitals to establish holding units for the management of critically ill patients with suspected COVID 19.
The private hospitals were directed to isolate the suspected patients, obtain samples and notify relevant bodies; continue to provide clinical care while ensuring all the standard operating procedures for the treatment of COVID 19; and only when positive results return should a consideration for referral be made.
However, Uganda medical Association President Dr Richard Idro said the directives of the Ministry of Health were unlikely to bring out the desired results, especially in the urban centres.
He argued that most people in urban centres first go to private facilities when they fall sick.
“In Kampala for example, there are 1,600 health units of which only 35 are hospitals. Patients are likely to go to the nearest health centre rather than look for the 35 hospitals such as Nakesero,” said Dr Idro.
“The small health centres which form over 95% of all health units have no room to set up these isolation facilities or put a tent, some even have no parking while others have very few staff and even fewer at night,” he emphasised.
“The holding units should meet standards of infection control but with which money? Few have the resources to put in place the kind of infection control measures required to care for potential COVID 19 patients or the PPE. During the 2-4 days the critically ill patient is being treated in the proposed holding units while waiting for results, may be receiving oxygen, with costs of over one million per day, who will pay for these costs?” Idro wondered.
A senior doctor advised that Uganda should pick a lesson from United Kingdom which in April built NHS Nightingale, the largest hospital facility to accommodate coronavirus patients needing intensive care treatment.
East London’s ExCeL exhibition centre, which normally plays host to lifestyle shows, expos and conferences, was converted into the temporary NHS Nightingale hospital, with space for 4,000 beds.
In nine days, the 87,328 square metres of double exhibition halls was fitted out with the framework for about 80 wards, each with 42 beds.
This, the doctor said, should be done at Namboole stadium.
Minister speaks out
Speaking in Lira on Thursday, Minister Ruth Aceng said Ugandans should not be worried as steps are being taken to accommodate the growing large numbers of COVID-19 patients.
“We don’t understand where the worry is coming from,” said Aceng.
“We have Namboole stadium which is large enough to accommodate these numbers. If we have more challenges, we will put tents outside. Better to put people who have the virus in a tent than bundling them together with those you are suspecting to have the virus,” said the Minister, emphasising, “So we don’t have a challenge as yet.”
Officials at Namboole say the facility was being used as a quarantine centre for some of the returnees.
Namboole has been fit with 300 beds but the capacity will be enhanced to 1,000 in the next few weeks, according to informed officials.
“People better be serious because hospitals are getting full. Space is running out very fast. We may reach a moment where patients may have nowhere to go,” said a medical source.
Dr Aceng said the touted homecare of COVID-19 patients was being studied to assess its viability.
“Even asymptomatic people seep the virus. In our population, the setup of our households is not conducive for isolation because people share amenities. You find four people in single rooms. They share bathrooms, toilets and utensils. It would have been easier to isolate people at home. In developed countries, you find each room is self-contained, making it easy to isolate people,” said Aceng.
“But here, the sick person, will be tempted to come out. We saw this between March and April at the onset of the pandemic. We tried self-isolation and many of the people would leave their homes to go to the centre of the city,” said the Minister.
“Even home in isolation, health personnel should follow you up after check on you every two days. But we have challenges of the human resource. Self-isolation of COVID-19 may end up spreading the virus even more,” said Aceng.
“That is why we continue to appeal to the population to embrace prevention guidelines and protect themselves from Coronavirus.”
Uganda, which initially performed well, has lately seen a sharp rise in the number of cases of Covid-19 as well as related deaths which now stand at 28.
President Museveni declared this Saturday, August 29 as a day for national prayers during which the country will once again seek divine invention to get through the Covid-19 pandemic.
- To prevent the spread of COVID-19:
- Clean your hands often. Use soap and water, or an alcohol-based hand rub.
- Maintain a safe distance from anyone who is coughing or sneezing.
- Wear a mask when physical distancing is not possible.
- Don’t touch your eyes, nose or mouth.
- Cover your nose and mouth with your bent elbow or a tissue when you cough or sneeze.
- Stay home if you feel unwell.
- If you have a fever, cough and difficulty breathing, seek medical attention.