Uganda – Pay or die: Ailing health system strips patients bare

Mamos Media

A health worker attends to patients in an ICU ward in Mulago Hospital. PHOTO/PROMISE TWINAMUKYE

By Frederic Musisi

Mr James Kabengwa, a Daily Monitor journalist, is alive today after coming close to death in hospital. His story resonates with those who have faced such a predicament inside Uganda’s broken health system.  
In September 2019, Mr Kabengwa booked himself into Mengo Hospital, a missionary-founded, private-not-for profit facility in Kampala, for a surgery to correct a redundant sigmoid colon—a condition where the large intestine cannot function normally.
The surgeon who diagnosed and operated him has more than 30 years’ experience.
“When you go to his office, on average, you will find not less than 30 patients; he has to attend to all of them, which means more money but it also means he doesn’t get to concentrate,” Mr Kabengwa narrates his ordeal.
Mr Kabengwa recalls that there were missteps during the surgery, leading to waste spilling inside his stomach. 
While in intensive care unit (ICU), he started swelling massively and his body turned pale. His caretakers suspected something was wrong but the nurses shrugged them off.
“In a matter of days, our bill had shot to around Shs15m, so the hospital started worrying that we would not pay, so they stopped medication. Even getting a nurse to check on me proved hard,” Mr Kabengwa recounts.
 “It didn’t matter that it was their mistake which took me in ICU,” he adds.
When his family was financially overwhelmed, they reached out to his colleagues who implored this newspaper’s editors to run a story appealing for help. 
He says it is when doctors learnt that the patient was a journalist that they started caring.
He underwent five unsuccessful surgeries after which doctors told his relatives to “pray to God.” 
Meanwhile, the bill had by this time  grown to Shs31m, which compelled him to check out.
It is until last December that he was recommended to a specialised private facility where he underwent a corrective surgery. It was discovered that a section of his large intestines had irreversibly been bypassed, and as such, he would not digest food properly. 
He was told it would take another three years for his system to adapt again, but not without complications such as interminable diarrhoea and emaciation because food cannot be absorbed easily.
 “I was angry; I was sad; I was helpless. I wanted to sue Mengo but decided to let it go,” Mr Kabengwa says. 
“It is until our colleague—JB (James Bugembe Ssenkubuge, a sports journalist)—died that I decided to speak out, realising that it could have been me.”
Since mid-1990s when government embraced the neo-liberal structural adjustment programmes agenda, including liberalisation, there was a fairly well-funded and functional health system.

Survival for the fittest
The emerging wide-range of private health facilities, the employer of most specialists, have turned into kingpins, charging astronomical fees. 
Those who cannot afford them are condemned to the public health system, rendered dysfunctional by incompetence, mismanagement, understaffing and poor remuneration, and corruption exposing a social-strata fault-line where the wealthy can only afford health services. 

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Surgeons in a theatre at Mulago Hospital in 2018. PHOTO/ RACHEL MABALA

Some specialists in the public hospitals also moonlight in private practice, often referring the financially overwhelmed patients to private outfits to buy special drugs, scans and diagnostics and laboratory services, among others.

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