Uganda: Doctors refer patients to clinics when hospital equipment is unused


Lying on her sickbed number 31 at the Gulu regional referral hospital, Ms. Rose Akullu, a 35-year-old single mother, is struggling with acute liver disease, hepatitis B.

Ms Akullu, a resident of Paidwe, Bobi Sub-County in Omoro District, who had previously been admitted to a local clinic in Omoro for an abdominal complication, arrived at the hospital on October 4 after being referred.

Once examined by doctors, she was recommended to undergo an urgent comprehensive blood test that included a liver scan and liver function tests to help with her diagnosis.

While in the hospital lab, Ms Akullu told Daily Monitor that she was advised to go and perform the tests at a private health facility, the Pole Clinical Laboratory, in the London neighborhood. hospital, because the hospital equipment had been damaged.

“They asked me to go to the Pole Clinical Laboratory, but when I got there the charges were over 100,000 Shs and it took me a week longer to liaise with my family at home to sell food stock to collect money, ”she said. .

Test results as of October 7 indicated that she was a high-risk patient with hepatocellular carcinoma, the most common type of primary liver cancer in adults resulting from hepatitis B.

Ms. Akullu says she was subsequently asked to do an ultrasound, and this time she referred to another facility named Piwan Medical Center in Gulu City.

The facility’s abdomino-pelvic ultrasound report, which this journal saw, indicated multiple tumors with a “grossly” enlarged liver and spleen.

“At the Pole Clinical Laboratories I spent 60,000 Shs while at the Piwan Medical Center I also spent a similar amount for the tests alone, not to mention the costs of essential drugs that I bought at the pharmacy then that I was on the sickbed here, ”she said. .

Like Ms Akulu, Mr Denis Olara, resident of Holy Rosary Cell in Laroo-Pece Division in Gulu City, was unable to meet medical costs for several tests on his organs when requested by the hospital. to do it from a private establishment.

Two weeks later, he raised funds and performed the tests at Flama Medical Center, a private health facility in the city of Gulu. She was diagnosed with acute pancreatitis on October 4.

Inactive equipment

Although he has since been registered for treatment in the medical ward, Olara faces a similar challenge to Akullu’s in bearing the high costs of purchasing drugs at private facilities.

While Ms Akullu says she spent more than Shs 350,000 on tests and the purchase of drugs and was bedridden for three weeks, Mr Olara was allowed (temporarily released) to return home and to look for money to help him carry out further tests.

“Right now, I am looking for money to do another test. I have requested my release to go home and look for money,” Olara said.

Several hepatitis B patients say they are asked to buy drugs from pharmacies and other private health facilities. The facility’s registry indicates that 595 hepatitis B patients are currently enrolled for care and treatment.

While patients are referred for testing and examinations from private facilities, our investigation established that the equipment used to perform blood tests, liver function tests and liver scans is available at the hospital. ‘hospital.

Among the machines available, but inactive were the HBsAg machine used to perform surface antigen screening tests for hepatitis B, semi-automated chemistry for liver function tests, and the hematology analyzer used for hepatitis B. complete blood tests.

Cost of liver diagnosis

A survey of several health establishments performing liver examinations indicated that a complete blood count costs around 20,000 Shs, the liver analysis costs between 25,000 Shs and 30,000 Shs while the liver function test costs between 45,000 Shs and 60,000 Shs.

Once patients have completed the tests, they come back with the results and present them to medical staff who then prescribe the drugs, some of which patients are asked to buy at private facilities.

Dr Joshua Wacha, doctor attached to a specialist clinic (diabetes, hepatitis, blood pressure, etc.) at the hospital admits that the machines are available and working.

He notes, however, that they (the machines) are unable to handle the overwhelming number of patients, prompting referrals.

“In the hospital here, the tools are there, but they cannot meet the demand, sometimes the demand is greater than that of the hospital, some will access it while others will not”, explains the Dr Wacha.

“Because the liver monitoring tools to do comprehensive tests, a complete blood count, a liver scan and all of that are expensive, it becomes difficult to monitor the progression of hepatitis B if it hits someone in a row. given time and has no money, ”he adds. .

Dr Wacha also says that when it comes to the medication, the patients get the medication, ”he added.

Mr. James Otim Onegiu, the hospital’s acting senior administrator, however, disagrees with Dr. Wacha. It refutes claims of broken or overused machines to test patients for hepatitis B.

He says there is a possibility where “either the interns make deals with private health facilities or our executives intend to do what we need to investigate.”

“When it comes to liver function tests, kidney function tests and complete blood counts, we have all of this equipment available in our labs at no cost, unless we go to the private wing of the. hospital and then you are asked to pay money, ”he said. adding: “A while ago we never had the reagents provided by National Medical Stores and that’s when patients were asked to go and do it. [testing] city, but since we have the supplies and all the reagents available, all the tests are available at the hospital. “

Disease burden

At the Pole Clinical Laboratory, of the 4,752 tests performed between May and August, 77 were for liver function tests on cases related to hepatitis B infections.

Laboratory staff member Dr Michael Okwonga said many patients have been referred by Gulu Regional Referral Hospital, Lacor Hospital and other health facilities in the sub-region.

At Flama Uganda, a private medical facility in the town of Gulu, records show that of 144 tests performed, 27 tested positive for hepatitis B. Dr Robert Alex Adiga, a laboratory technician working at the facility , said many patients had been referred from Gulu. Hospital.

Data from the Gulu District Health Department shows that 832 patients were diagnosed with hepatitis B between January 2020 and February 2021. The data was collected from 60 different health facilities in the district. Twenty-nine of the patients succumbed to the disease, seven succumbed to cirrhosis of the liver while three died from hepatocellular carcinoma.

While 172 patients were admitted to Gulu Hospital, 55 were at St Mary Lacor Hospital. The disease prevalence rate in the district is 10 percent.

Lillian L. Pena

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